DOT Rule 49 CFR Part 40 Appendix D
Appendix D to Part 40 - Report Format: Split Specimen Failure to Reconfirm
Mail, fax, or submit electronically to:
U.S. Department of Transportation
Office of Drug and Alcohol Policy and Compliance
1200 New Jersey Avenue, S.E.
Washington, DC 20590
Fax: (202) 366-3897
The following items are required on each report:
- MRO name, address, phone number, and fax number.
- Collection site name, address, and phone number.
- Date of collection.
- Specimen I.D. number.
- Laboratory accession number.
- Primary specimen laboratory name, address, and phone number.
- Date result reported or certified by primary laboratory.
- Split specimen laboratory name, address, and phone number.
- Date split specimen result reported or certified by split specimen laboratory.
- Primary specimen results (e.g., name of drug, adulterant) in the primary specimen.
- Reason for split specimen failure-to-reconfirm result (e.g., drug or adulterant not present, specimen invalid, split not collected, insufficient volume).
- Actions taken by the MRO (e.g., notified employer of failure to reconfirm and requirement for recollection).
- Additional information explaining the reason for cancellation.
- Name of individual submitting the report (if not the MRO).
[65 FR 79526, Dec. 19, 2000, as amended 73 FR 35975, June 25, 2008; 82 FR 52247, November 13, 2017]