The CG-719P form is the official DOT/USCG Periodic Drug Testing Form issued by the U.S. Coast Guard to confirm that mariners satisfy periodic drug testing requirements under Title 46 CFR 16.220. This form is required for credentialed mariners who are not enrolled in a random or pre-employment USCG-approved drug testing program.
Who Must Complete This Form
The CG-719P applies to licensed officers, deck ratings, and STCW certificate holders seeking to renew or obtain a Merchant Mariner Credential (MMC). The applicant is responsible for the cost of testing. Anyone who falsifies any part of this form risks federal prosecution, so accuracy is critical.
Key Sections of the CG-719P
Section I captures applicant information including full name, date of birth, and USCG credential number, as well as the specimen identification number and the name of the SAMHSA-accredited testing laboratory. Section II is completed by a qualified Medical Review Officer (MRO), who verifies and certifies the test result according to DOT drug testing standards. The MRO must provide contact information, signature, and authority information confirming the chain of custody.
For mariners who must submit a credential application alongside drug testing results, the CG-719B form covers initial applications. The CG-719S form addresses pre-employment and follow-up testing. A drug testing consent form may also be required by the testing facility before specimen collection.
| Question | Answer |
|---|---|
| Form Name | Cg 719P Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | uscg cg 719p form, uscg drug test form, uscg dot form, dhs uscg dot form |