Appendix D - Appendix D to Part 40—DOT Drug Testing Semi-Annual Laboratory Report to Employers
The following items are required on each laboratory report:
Reporting Period: (inclusive dates) Laboratory Identification: (name and address) Employer Identification: (name; may include Billing Code or ID code) C/TPA Identification: (where applicable; name and address) A. Urine Specimens 1. Urine Specimen Results Reported (Total Number) By Test Reason (a) Pre-employment (number) (b) Post-Accident (number) (c) Random (number) (d) Reasonable Suspicion/Cause (number) (e) Return-to-Duty (number) (f) Follow-up (number) (g) Type of Test Not Noted on CCF (number) 2. Urine Specimens Reported (a) Negative (number) (b) Negative and Dilute (number) 3. Urine Specimens Reported as Rejected for Testing (Total Number) by Reason (a) Fatal flaw (number) (b) Uncorrected Flaw (number) 4. Urine Specimens Reported as Positive (Total Number) by Drug (a) Marijuana Metabolite (number) (b) Cocaine Metabolite (number) (c) Opioids (number) (1) Codeine (number) (2) Morphine (number) (3) 6-AM (number) (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. Urine Adulterated (Number) 6. Urine Substituted (Number) 7. Urine Invalid Result (Number) B. Oral Fluid Specimens 1. Oral Fluid Specimen Results Reported (Total Number) by Test Reason (a) Pre-employment (number) (b) Post-Accident (number) (c) Random (number) (d) Reasonable Suspicion/Cause (number) (e) Return-to-Duty (number) (f) Follow-up (number) (g) Type of Test Not Noted on CCF (number) 2. Oral Fluid Specimens Reported (a) Negative (number) (b) Negative and Dilute (number) 3. Oral Fluid Specimens Reported as Rejected for Testing (Total Number) by Reason (a) Fatal flaw (number) (b) Uncorrected Flaw (number) 4. Oral Fluid Specimens Reported as Positive (Total Number) by Drug (a) Marijuana (number) (b) Cocaine and/or Cocaine Metabolite (number) (c) Opioids (number) (1) Codeine (number) (2) Morphine (number) (3) 6-AM (number) (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. Oral Fluid Adulterated (Number) 6. Oral Fluid Substituted (Number) 7. Oral Fluid Invalid Result (Number)