Phone *

(###)

###

####

DOT Agency *

FMCSA

FAA

USCG

PHMSA

FTA

FRA

Effective Date of policy *

MM

DD

YYYY

Do you need a non- DOT policy too? *

YES

NO

Specimen Type *

(select all that apply)

DOT Required (Urine)

Hair (If you want to include hair too)

In the case of a positive drug test what will be the consequence?

Immediate Termination

Second chance - (Employee must complete a SAP- Substance Abuse Professional, subjecting to a second chance agreement, any further positive test or refusal will result to immediate termination & removed from safety sensitive position

Other (Detailed description)

In case of a positive alcohol test, what will be the consequence? *

Same as for positive drug test

Other (Detailed description)

In case of a refusal, what will be the consequence? *

Same as for positive drug test

Other (Detailed description)

In case of a negative dilute specimen on a current employee, what will be the consequence? *

Result can be accepted as is

Employee must retest along with a supervisor to escort the employee

In case of a negative dilute specimen on a hired applicant, what will be the consequence? *

Result can be accepted as is

Applicant must retest within a 24-hour period and come up with a non-diluted specimen to further receive the position

Does your company have a SAP in place? *

(If not, you can research your nearest SAP through search engine & then provide us the following info)

Yes

No

An invoice will be sent you shortly or a call for upfront payment *

Email My invoice

Text my invoice

Call me for payment

I agree to terms & conditions *

I AGREE

Once a payment has been submitted, we will begin to work on your policy *

I AGREE