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DOT Drug And Alcohol Testing Request Form Mobile App

The Department of Transportation (DOT) Drug and Alcohol Testing Request Form is an employee services document where an employer can request a variety of tests, including the DOT Drug Test, Non-DOT Drug Testing, DOT Breath Alcohol Test, and DOT Physical. The form can be customized to request alternative tests as well as remove DOT tests currently listed on the form. The reason for testing can also be captured using this app, with set reasons for an employee's drug test included in a dropdown, such as pre-employment screenings, random drug screenings, return to work screenings, reasonable suspicion screenings, follow-up screening, as well as post-accident screenings where the date and time of the accident can also be entered. There are also areas of the form that can be edited to add Lab, Medical Review Officer (MRO), and Third Party Administrator (TPA) details.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date

  • Ico textbox

    Company

  • Ico textbox

    Street Address

  • Ico textbox

    City

  • Ico dropdown

    State

  • Ico textbox

    Zip Code

  • Ico textbox

    Phone Number

  • Ico statictext

  • Ico textbox

    Designated Employer Representative (DER)

  • Ico textbox

    Employee's Name

  • Ico textbox

    Employee ID

  • Ico dropdown

    Please perform only the services marked below

  • Ico dropdown

    Reason For Test

  • Ico date

    Post-Accident Date

  • Ico time

    Post-Accident Time

  • Ico statictext

  • Ico statictext

    TO CLINIC PERFORMING SERVICE: You may have both kits and chain of custody forms on file for this ...

  • Ico statictext

    To ensure no disruption or delays in the turnaround time on drug test results, you must FAX the M...

  • Ico statictext

    {Insert Lab name and address and MRO name and address}

  • Ico statictext

    {Insert Third Party Administrator (TPA) name and address}

  • Ico statictext

    Billing Information: {insert billing information}

  • ...and More!

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