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Drug Screen Form PDF Details

A drug screen form, also known as a urinalysis, is a test that helps to detect illegal drugs and prescription medications in the urine. The test is used by employers, law enforcement, and other organizations to determine if someone has been using drugs. The time it takes for drugs to be eliminated from the body varies depending on the drug, but most drugs will be detectable in urine for up to 72 hours after use. There are many different methods for conducting a drug screen, but the most common is the immunoassay method. This method uses antibodies to bind to specific drugs or metabolites in the urine and then creates a reaction that can be measured.

The listing holds information regarding the drug screen form. This figure will provide specifics of the form's size, completion duration, and the blanks you may be expected to fill.

Question	Answer
Form Name	Drug Screen Form
Form Length	1 pages
Fillable?	Yes
Fillable fields	91
Avg. time to fill out	18 min 31 sec
Other names	12 panel drug test result form, drug test form, printable drug test form, drug test results form

12

Form Preview Example

FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM

800-877-7484

SPECIMEN ID NO.
STEP 1: COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE	LAB ACCESSION NO.

<![endif]>Quest, Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics Incorporated. © Quest Diagnostics Incorporated. All rights reserved. QD20315-FED. Revised 10/10. SC2K - 111192.

A. Employer Name, Address, I.D. No.

B. MRO Name, Address, Phone and Fax No.

C. Donor SSN or Employee I.D. No. _______________________________________________________________

D. SpecifyTesting Authority: HHS

NRC

DOT – Specify DOT Agency: FMCSA

FAA

FRA FTA PHMSA USCG

E. Reason forTest: Pre-employment

Random

Reasonable Suspicion Cause Post Accident

Return to Duty

Follow-up Other (specify) ____________________________

F. DrugTests to be Performed:

THC, COC, PCP, OPI, AMP

THC & COC Only

Other (specify) ________________________________________________

G. Collection Site Name:

Collection Site Code:

Address:

Collector Phone No.:

City, State and Zip:

Collector Fax No.:

STEP 2: COMPLETED BY COLLECTOR (make remarks when appropriate) Collector reads specimen temperature within 4 minutes.

Temperature between 90° and 100° F? Yes No, Enter Remark

Collection: Split Single None Provided, Enter Remark

Observed, (Enter Remark)

REMARKS

STEP 3: Collector affixes bottle seal(s) to bottle(s). Collector dates seal(s). Donor initials seal(s). Donor completes STEP 5 on Copy 2 (MRO Copy)

STEP 4: CHAIN OF CUSTODY - INITIATED BY COLLECTOR AND COMPLETED BY TEST FACILITY

	I certify that the specimen given to me by the donor identified in the certification section on Copy 2 of this form was								SPECIMEN BOTTLE(S) RELEASED TO:
	collected, labeled, sealed, and released to the Delivery Service noted in accordance with applicable Federal requirements.							Quest Diagnostics Courier
		X						FedEx
		Signature of Collector						Other
		Signature of Collector
						AM
						PM
		(Print) Collector's Name (First, MI, Last)	Date (Mo./Day/Yr.)			Time of Collection				Name of Delivery Service
RECEIVED AT LAB OR IITF:								Primary Specimen		SPECIMEN BOTTLE(S) RELEASED TO:
	X							Bottle Seal Intact
	X							Yes No
		Signature of Accessioner						Yes No
		Signature of Accessioner
								If No, Enter remarks
								in Step 5A.
		(Print) Accessioner’s Name (First, MI, Last)				Date (Mo./Day/Yr.)		in Step 5A.

STEP 5A: PRIMARY SPECIMEN REPORT - COMPLETED BY TEST FACILITY

NEGATIVE	POSITIVE for:	Marijuana Metabolite ( 9-THCA)		6- Acetylmorphine	Methamphetamine	MDMA
DILUTE			Cocaine Metabolite (BZE)	Morphine	Amphetamine	MDA
			PCP	Codeine		MDEA
REJECTED FOR TESTING	ADULTERATED		SUBSTITUTED	INVALID RESULT

REMARKS:

Test Facility (if different from above):

I certify that the specimen identified on this form was examined upon receipt, handled using chain of custody procedures, analyzed, and reported in accordance with applicable Federal requirements.

X

Signature of Certifying Scientist

(Print) Certifying Scientist's Name (First, MI, Last)

Date (Mo./Day/Yr.)

STEP 5b: COMPLETED BY SPLIT TESTING LABORATORY

RECONFIRMED FAILED TO RECONFIRM - REASON ____________________________________________

___________________________________________

I certify that the split specimen identified on this form was examined upon receipt, handled using chain of custody

procedures, analyzed and reported in accordance with applicable Federal requirements.

Laboratory Name

___________________________________________

X

Signature of Certifying Scientist

(Print) Certifying Scientist's Name (First, MI, Last)

Date (Mo./Day/Yr.)

Laboratory Address

<![endif]>OMB No. 0930-0158

<![endif]>PRESS HARD - YOU ARE MAKING MULTIPLE COPIES

How to Edit Drug Screen Form Online for Free

It is really very easy to fill out the drug test paperwork empty blanks. Our PDF tool can make it practically effortless to fill out almost any PDF. Below are the only four steps you should follow:

Step 1: You should select the orange "Get Form Now" button at the top of this page.

Step 2: Now, you can start modifying the drug test paperwork. Our multifunctional toolbar is readily available - add, remove, transform, highlight, and carry out various other commands with the text in the file.

The next segments are contained in the PDF file you will be filling in.

entering details in drug screen form template part 1

Enter the demanded details in the space PRESS, HARD YOU, A, REMAK, NG, MULT, PLE, COPES fo, sk, ram, e, darte, h, ter, ask, rams, c, it, song, aD t, seu, Q, de, tacos, s, a a, dna, ogo de, tacos, sae, ht sci, tsonga, D t, seu, Q t, seu, Q Signature, of, Collector AM, PM Print, Collectors, Name, First, MI, Last Date, Mo, Day, Yr Time, of, Collection and RECEIVED, AT, LABOR, I, IT, FX

drug screen form template PRESSHARD, YOUAREMAKNGMULTPLECOPES, foskramedartehteraskramscitsongaD, tseuQdetacossa, adnaogo, detacossaeht, scitsongaD, tseuQ, tseuQ, SignatureofCollector, AMPM, PrintCollectorsNameFirstMILast, DateMoDayYr, TimeofCollection, and RECEIVEDATLABORIITFX fields to fill

Step 3: Press the "Done" button. It's now possible to transfer the PDF file to your device. Besides, you can easily send it through electronic mail.

Step 4: It will be easier to keep duplicates of your form. You can rest easy that we are not going to publish or see your details.

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