Implementation Guidelines - Federal Transit Administration - U.S. ...

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PAPERWORK REDUCTION ACT NOTICE (as required by 5 CFR 1320.21) According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 2105-0529. The Department of Transportation estimates that the average burden for this report form is 1.5 hours. You may send comments regarding this burden estimate or any suggestions for reducing the burden to: U.S. Department of Transportation, Office of Drug and Alcohol Policy and Compliance, Room 10403, 400 Seventh Street, SW, Washington, D.C. 20590; OR Office of Management and Budget, Paperwork Reduction Project, 725 Seventeenth Street, NW, Washington, D.C. 20503. Title 18, USC Section 1001, makes it a criminal offense subject to a maximum fine of $10,000, or imprisonment for not more than 5 years, or both, to knowingly and willfully make or cause to be made any false or fraudulent statements of representations in any matter within the jurisdiction of any agency of the United States. Page 93 of 100
Page 94 of 100 The following form and instructions must be used when an employer is required to report MIS data to a DOT agency. U.S. DEPARTMENT OF TRANSPORTATION DRUG AND ALCOHOL TESTING MIS DATA COLLECTION FORM INSTRUCTION SHEET This Management Information System (MIS) form is made-up of four sections: employer information; covered employees (i.e., employees performing DOT regulated safety-sensitive duties) information; drug testing data; and alcohol testing data. The employer information needs only to be provided once per submission. However, you must submit a separate page of data for each employee category for which you report testing data. If you are preparing reports for more than one DOT agency then you must submit DOT agency-specific forms. Please type or print entries legibly in black ink. TIP ~ Read the entire instructions before starting. Please note that USCG-regulated employers do not report alcohol test results on the MIS form. Calendar Year Covered by this Report: Enter the appropriate year. Section I. Employer 1. Enter your company’s name, to include when applicable, your “doing business as” name; current address, city, state, and zip code; and an e-mail address, if available. 2. Enter the printed name, signature, and complete telephone number of the company official certifying the accuracy of the report and the date that person certified the report as complete. 3. If someone other than the certifying official completed the MIS form, enter that person’s name and phone number on the appropriate lines provided. 4. If a Consortium/Third Party Administrator (C/TPA) performs administrative services for your drug and alcohol program operation, enter its name and phone number on the appropriate lines provided. 5. DOT Agency Information: Check the box next to the DOT agency for which you are completing this MIS form. Again, if you are submitting to multiple DOT agencies, you must use separate forms for each DOT agency. a. If you are completing the form for FMCSA, enter your FMCSA DOT Number, as appropriate. In addition, you must indicate whether you are an owner-operator (i.e., an employer who employs only himself or herself as a driver) and whether you are exempt from providing MIS data. Exemptions are noted in the FMCSA regulation at 382.103(d). b. If you are completing the form for FAA, enter your FAA Certificate Number and FAA Antidrug Plan / Registration Number, when applicable. c. If you are completing the form for PHMSA, check the additional box(s) indicating your type of operation. d. If you are completing the form for FRA, enter the number of observed/documented Part 219 “Rule G” Observations for covered employees. e. If you are submitting the form for USCG, enter the vessel ID number. If there is more than one number, enter the numbers separately. Section II. Covered Employees 1. In Box II-A, enter the total number of covered employees (i.e., employees performing DOT regulated safetysensitive duties) who work for your company. Then enter, in Box II-B, the total number of employee categories that number represents. If you have employees, some of whom perform duties under one DOT agency and others of whom perform duties under another DOT agency, enter only the number of those employees performing duties under the DOT agency for whom you are submitting the form. If you have covered employees who perform multi-DOT agency functions (e.g., an employee drives a commercial motor vehicle and performs pipeline maintenance duties for you), count the employee only on the MIS report for the DOT agency regulating more than 50 percent of the employee’s safety sensitive function.
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October 2009 Implementation Guideli
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Notice This document is disseminate
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METRIC/ENGLISH CONVERSION FACTORS E
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Table of Contents Chapter 1. INTROD
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Table of Contents (continued) Secti
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Chapter 1. INTRODUCTION Section 1.
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Transit employers may go beyond the
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Recommendation: Know the Regulation
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Sample Documentation Chapter 1. Int
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DHHS-Certified Laboratories, Center
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FTA Drug and Alcohol Management Inf
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Research And Special Programs Admin
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employment in safety-sensitive posi
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What happens in these cases? The pu
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Section 3. SAFETY-SENSITIVE • Ope
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performing the volunteer service ar
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Safety-sensitive Examples of Nation
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• A description of the consequenc
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projects, the employer should notif
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Sample Documentation Chapter 2. Reg
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Certification of Compliance for FTA
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4. Atlanta Federal Center Suite 17T
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1. Liability of Service Agents Yasu
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plaintiffs agreed that their positi
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FTA and FMCSA Regulatory Comparison
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FTA and FMCSA Regulatory Comparison
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process ensures that all critical c
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Chapter 3. Program Formulation 3-4
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Chapter 4. POLICY DEVELOPMENT AND C
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concentration of 0.04 or greater th
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has a confirmed alcohol concentrati
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MRO before the employer is notified
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policy with the requirement to form
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Do not assume that your contractors
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PRE-EMPLOYMENT DRUG TESTING NOTIFIC
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Sample Program Notification Letter
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authorized by the employer to make
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The 60 minutes of awareness trainin
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medications which could result in p
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employees who have problems with pr
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particular alcohol testing device t
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emain current with the regulations
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− Changes in Rules, Guidance and
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Exhibit 5-1 Summary of Education an
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Exhibit 5-3 Typical Agenda for Supe
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Exhibit 5-4 REASONABLE SUSPICION TR
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Chapter 6. TYPES OF TESTING Six typ
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Previous DOT Employer Record Check
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the “insufficient volume” proce
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for employees what is meant by on-d
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Nonfatal accidents involving a bus,
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Testing for drugs and alcohol follo
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iases in the process. To be conside
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1. Determine how frequently random
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In many small transit systems, ever
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Before making the return-to-duty re
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up testing program. The SAP must do
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Employee Discharged BAC >= 0.04 Con
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Employee Discharged Split Specimen
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Sample Documentation Chapter 6. Typ
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1) Accident Report Number: 2) Locat
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Chapter 7. DRUG TESTING PROCEDURES
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Recommendation Multiple Collection
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spouse, relative) or a close person
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The DOT requires the new version of
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9. The collector must direct the em
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evening contact telephone numbers i
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temperature range (90.0 to 100.0 F)
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publishes its final rule establishi
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for the preceding 6 months ending o
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Chapter 7. Drug Testing Procedures
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• The MRO will verify the test re
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The MRO may change a verified test
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direct the DER to have the employee
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employee for a retest under direct
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Sample Documentation Chapter 7. Dru
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Collection Site Checklist (cont.) (
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12. You may now wash your hands and
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Privacy Act Statement: (For Federal
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than an EBT, that is approved by th
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Breath Alcohol Technician (§40.213
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availability and the need for backu
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At the conclusion of the screen tes
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sufficient amount of breath. A medi
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In addition to stipulating the cons
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Sample Documentation Chapter 8. Alc
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[Federal Register: May 4, 2001 (Vol
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The Conforming Products List is the
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Highway Safety Programs; Model Spec
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45420 Federal Register / Vol. 65, N
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45422 Federal Register / Vol. 65, N
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U.S. Department of Transportation (
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Section 1. SAP QUALIFICATIONS A sub
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Education/Treatment Program Referra
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Employers are not required to follo
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SAP, many employers have looked to
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10 weeks, with most sessions schedu
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_____________________________ _____
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FOLLOW-UP TESTING PROCESS SAP Input
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Alcohol Test Results
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when the applicant was assigned saf
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may arrange to have the consortium
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• Employers and service agents sh
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The list of randomly selected trans
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A. At a Nonprofit Agency or Indepen
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Reporting Period: Laboratory Name a
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Record Retention Checklists (page 2
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Retains CCF1 Split Lab - CCF1 Labor
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CCF1 Split Lab Retains - CCF1 Labor
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U.S. DEPARTMENT OF TRANSPORTATION D
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Chapter 11. CONSORTIA AND THIRD PAR
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Greater Expertise. The FTA and DOT
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Section 2. CONSIDERATIONS IN ESTABL
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esults (≥0.02) between the BAT an
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consideration. Thus, the more diver
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Section 5. IS A CONSORTIUM RIGHT FO
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• Procurement of testing services
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• Consider which consortium model
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Exhibit 11-1 Role of State DOTs in
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Exhibit 11-3 CONSORTIA RESPONSIBILI
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Chapter 12. PROGRAM MONITORING As a
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• Conduct periodic review of serv
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compliance. You are encouraged to c
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Chapter 13. THE DRUG-FREE WORKPLACE
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Violations of the act may result in
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Exhibit 13-1 DRUG-FREE WORKPLACE AC
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Chapter 14. SUBSTANCE ABUSE MANAGEM
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Notification of audit Requested mat
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them to move throughout the facilit
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above materials. ⎯⎯Procedures t
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DAY 3 Time Activity Team Address of
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Date of Collection Jan-01 Nov-00 Se
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Time of the Test Time of the Test 8
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Each auditor will discuss the porti
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Sample Re-audit Agenda DAY 1 Time A
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Index of Appendices Appendix A. Acr
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AA Alcoholics Anonymous Appendix A.
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RFP Request for Proposal RIA Radio
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Newsletters Appendix B. Additional
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U.S. Department of Labor. What Work
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Other Government Web sites Drug and
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Appendix C Americans with Disabilit
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sensitive duties for the illegal us
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If the individual is qualified and
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allegation of discrimination under
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Appendix D. Certified Laboratories
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DrugProof, Divison of Dynacare 543
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One Source Toxicology Laboratory, I
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The following laboratories are volu
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Federal Register / Vol. 65, No. 141
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Appendix F. Fact Sheets Drug Detect
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Social Issues • Two-thirds of all
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• The euphoric stimulation increa
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• Paranoia • Profuse sweating a
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connection between marijuana smokin
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Opiates (Narcotics) Fact Sheet Opia
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Phencyclidine (PCP) Fact Sheet Phen
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Appendix G Questions and Answers
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ecipient, and someone other than th
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Q. Can transit operators receive wa
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Q. If an employee changed jobs prio
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Q. How much training are employers
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acceptable for the company-required
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Q. In a post-accident situation req
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employees and 50 non-DOT employees,
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Q: What actual address is required
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Q: Can a split specimen be sent to
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actual employee of the employer may
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Q: Must collectors, BATs, STTs, MRO
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an observer, or a monitor for co-wo
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Q: If a collector makes an error on
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Appendix H Terms and Definitions
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indirectly, one controls or has the
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Confirmation validity test Confirme
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These terms include any designee of
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Medical Review Officer (MRO) A pers
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Random test Reason to believe Reaso
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Safety-sensitive function Any of th
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trolley bus, or vessel. A “mass t
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49 CFR Part 40 Updated August 31, 2
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§ 40.89 What is validity testing,
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Page 4 of 100 § 40.287 What inform
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Page 6 of 100 Subpart A - Administr
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Page 8 of 100 Medical Review Office
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Page 10 of 100 § 40.17 Is an emplo
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Page 12 of 100 (b) You must request
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Page 14 of 100 (4) The collector's
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Page 16 of 100 (1) To avoid distrac
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Page 18 of 100 (f) Direct the emplo
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Page 20 of 100 (g) As the collector
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Page 22 of 100 participate in the D
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Page 24 of 100 (b) You must determi
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Page 26 of 100 (d) If you have not
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Page 28 of 100 December 31 of the p
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Page 30 of 100 (a) Review Copy 2 of
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Page 32 of 100 (1) As the DER, you
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Page 34 of 100 (i) Recent needle tr
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Page 36 of 100 (2) If you receive i
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Page 38 of 100 (iii) If a negative
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Page 40 of 100 (6) Result of the te
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Page 417 and 418: Page 44 of 100 (1) Report that the
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Page 421 and 422: Page 48 of 100 (c) The laboratory r
Page 423 and 424: Page 50 of 100 (6) The failure to d
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Page 427 and 428: Page 54 of 100 (c) As the user of t
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Page 431 and 432: Page 58 of 100 (i) You may transmit
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Page 437 and 438: Page 64 of 100 § 40.295 May employ
Page 439 and 440: Page 66 of 100 (e) The requirements
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Page 443 and 444: Page 70 of 100 § 40.343 What tasks
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Page 447 and 448: Page 74 of 100 (b) In exercising th
Page 449 and 450: Page 76 of 100 resubmit the matter
Page 451 and 452: Page 78 of 100 § 40.397 When does
Page 453 and 454: Appendix A to Part 40 - DOT Standar
Page 455 and 456: Appendix C to Part 40-DOT Drug Test
Page 457 and 458: Page 84 of 100 Appendix E to Part 4
Page 459 and 460: Appendix G to Part 40—Alcohol Tes
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Page 465: I. Employer: Company Name: Page 92
Page 469 and 470: Section III. Drug Testing Data Page
Page 471 and 472: Page 98 of 100 TIP ~ Even though so
Page 473 and 474: Page 100 of 100 Finally, additional
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Page 495 and 496: Federal Register / Vol. 68, No. 250
Page 507 and 508: 49 CFR Part 655
Page 509 and 510: 2 Electronic access to this rule an
Page 511 and 512: duty and follow-up testing under sp
Page 513 and 514: When the drug and alcohol rules ini
Page 515 and 516: the consequences for prohibited dru
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Labor unions: 3 Trade associations:
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FTA Response. FTA opts not to inclu
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Since each employer uses its own te
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Most of the commenters to this sect
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themselves that employees can succe
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Several commenters responding to th
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service providers and the employer.
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esponsibility of FTA transit funds
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26 Federalism assessment. However,
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Part 655 - Prevention of Alcohol Mi
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655.52 Substance abuse professional
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(b) This part must be read in conju
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(2) The volunteer performs a safety
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Refuse to submit means any circumst
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An employer must have an anti-drug
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part. (c) Specific information conc
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(5) Phencyclidine. (c) Consumption
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concentration less than 0.04. This
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§655.43 Reasonable suspicion testi
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48 the reasons the alcohol test was
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(c) Rates for drug testing. (1) Whe
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annual percentage rate under this p
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(a) Each employer shall require a c
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56 for evaluating and resolving pro
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qualifying the supervisors to make
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60 (12) Number of covered employees
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post-accident alcohol test indicati
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equired to be maintained by this pa
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(b) A certification must be authori
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Drug-Free Workplace Act
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TABLE OF CONTENTS INTRODUCTION ....
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egulations that have been made sinc
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The behaviors that are prohibited b
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⎯ An individual who refuses to su
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Have employees been notified that p
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⎯ Add a bluing agent to the toile
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Are employees who are subject to te
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LABORATORY TESTING Are all drug tes
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⎯ Direct the analysis of the spli
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Is only one test conducted at a tim
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Does the BAT notify the employer’
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Does the SAP evaluate whether a saf
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ADMINISTRATIVE REQUIREMENTS If a pr
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Are procedures in place to have emp
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hours following the accident, the e
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Are random numbers substituted only
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Are employees that are subject to f
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OTHER TRAINING Consistent with the
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♦ Documents presented by a covere
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CERTIFICATION ♦ Each year transit
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A R DMINISTRATIVE EQUIREMENTS Do th
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DRUG AND ALCOHOL POLICY REVIEW QUES
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Meeting FTA thresholds; Meeting dru
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CONSEQUENCES OF A FAILED OR REFUSED
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How much notice is given to the emp
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RECORDS MANAGEMENT QUESTIONNAIRE AP
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If the information requested is not
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Has the employer met the minimum an
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Do the records indicate that any dr
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Does the employer utilize the stand
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If tests are cancelled because of a
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If you conducted the initial test,
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SALIVA TEST TECHNICIAN QUESTIONNAIR
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MEDICAL REVIEW OFFICER (MRO) QUESTI
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What action would you take if the s
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• • • As the SAP, can you sub
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Do you assist your members in any w
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