Appendix D to Part 40 Appendix D to Part 40—DOT Drug Testing Semi-Annual Laboratory Report to Employers

Mail,The fax,following oritems submitare electronicallyrequired toon each laboratory report:
U.S.Reporting DepartmentPeriod: of(inclusive Transportation,dates)
Laboratory OfficeIdentification: of(name Drug and Alcoholaddress)
Employer PolicyIdentification: and(name; Compliance,may W62-300,include 1200Billing NewCode Jerseyor AvenueID SEcode)
C/TPA Identification: (where applicable; name and address)
A., Washington,Urine DCSpecimens
1. 20590,Urine Fax:Specimen Results Reported (202Total Number) 366By Test Reason
(a) Pre-3897.employment (number)
Submit(b) Electronically:Post-Accident https:(number)
(c) Random (number)
(d) Reasonable Suspicion//www.transportation.gov/content/splitCause (number)
(e) Return-specimento-cancellationDuty (number)
(f) Follow-notification-49-cfr-part-40187-appendix-dup (number)
The(g) followingType itemsof areTest requiredNot Noted on eachCCF report:(number)
12. MROUrine name,Specimens address,Reported
(a) phoneNegative (number,)
(b) Negative and faxDilute (number.)
23. CollectionUrine siteSpecimens name,Reported address,as andRejected phonefor Testing (Total Number) by Reason
(a) Fatal flaw (number.)
3.(b) DateUncorrected ofFlaw collection.(number)
4. SpecimenUrine I.D.Specimens number.Reported as Positive (Total Number) by Drug
5.(a) LaboratoryMarijuana accessionMetabolite (number.)
6.(b) PrimaryCocaine specimenMetabolite laboratory(number)
(c) name,Opioids address,(number)
(1) andCodeine phone (number.)
7.(2) DateMorphine result(number)
(3) reported6-AM or(number)
(4) certifiedHydrocodone by(number)
(5) primaryHydromorphone laboratory.(number)
8.(6) SplitOxycodone specimen(number)
(7) laboratoryOxymorphone name,(number)
(d) address,Phencyclidine and(number)
(e) phoneAmphetamines (number.)
9.(1) DateAmphetamine split(number)
(2) specimenMethamphetamine result(number)
(3) reportedMDMA or(number)
(4) certifiedMDA by(number)
5. splitUrine specimenAdulterated laboratory(Number)
6. Urine Substituted (Number)
107. PrimaryUrine specimenInvalid resultsResult (eNumber)
B.g Oral Fluid Specimens
1., nameOral ofFluid drug,Specimen adulterantResults Reported (Total Number) inby theTest primaryReason
(a) specimen.Pre-employment (number)
11.(b) ReasonPost-Accident for(number)
(c) splitRandom specimen(number)
(d) failureReasonable Suspicion/Cause (number)
(e) Return-to-reconfirmDuty result(number)
(f) Follow-up (e.number)
(g.,) drugType orof adulterantTest notNot present,Noted specimenon invalid,CCF split(number)
2. notOral collected,Fluid insufficientSpecimens volumeReported
(a). Negative (number)
12(b) Negative and Dilute (number)
3. ActionsOral takenFluid Specimens Reported as Rejected for Testing (Total Number) by theReason
(a) MROFatal flaw (enumber)
(b) Uncorrected Flaw (number)
4.g., notifiedOral employerFluid ofSpecimens failureReported toas reconfirmPositive (Total Number) by Drug
(a) Marijuana (number)
(b) Cocaine and/or requirementCocaine forMetabolite recollection(number).
13.(c) AdditionalOpioids information(number)
(1) explainingCodeine the(number)
(2) reasonMorphine for(number)
(3) cancellation.6-AM (number)
14(4) Hydrocodone (number)
(5) Hydromorphone (number)
(6) Oxycodone (number)
(7) Oxymorphone (number)
(d) Phencyclidine (number)
(e) Amphetamines (number)
(1) Amphetamine (number)
(2) Methamphetamine (number)
(3) MDMA (number)
(4) MDA (number)
5. NameOral ofFluid individualAdulterated submitting(Number)
6. theOral reportFluid Substituted (ifNumber)
7. notOral theFluid MROInvalid Result (Number)
[8288 FR 5224727651, Nov.May 132, 20172023]