Collection Site Checklist


Name of Collection Site: _____________________________________________
Date of Review: _________________________
Name of Collector: _____________________________________ Name of Reviewer: ___________________________________
49 CFR Part 40. You may view this form on the
ODAPC website ( )
(result less than 0.02) - Did the Breath Alcohol
 Were all necessary equipment, personnel, and materials for
Technician (BAT)...
breath testing provided at the location where testing
 Require employee to provide positive photo identification
occurred? (40.221(d))
(Part 40.241(c)).
 Did the breath alcohol testing location afford visual and
 Perform the Alcohol test before the drug test, if applicable
aural privacy to prevent unauthorized persons from seeing
 Explain testing procedures on back of Alcohol Testing
or hearing test results? (40.221(c))
Form (ATF) (40.241(e))
 Did the BAT remain with the employee for the entire
 Complete Step 1 of ATF (40.241(f))
duration of the alcohol testing procedure? (40.223(e)(3))
− Employee Name, ID Number
 Does the BAT have a copy of the quality assurance plan
− Employer Name and Contact information
(QAP) for the EBT? (40.233(c))
− DER Name and Telephone Number
 Ask to see the external calibration checks for the EBT
− Reason for Test
 Have the employee complete Step 2 of the ATF (40.241(g))
 Have the BATs completed the required training and
 Open individually sealed mouthpiece and attach to EBT
acquired the proper credentials? (40.213(g))
 Ask to see the credentials of the BAT
 Instruct employee to blow forcefully until EBT indicates
 Does the BAT have a current copy of 49 CFR Part 40?
that an adequate amount of breath has been obtained
 Show employee the result displayed on EBT (40.243(d))
 If EBT prints result on paper strip: Did the BAT affix the
the Collector…
strip to the ATF using tamper evident tape (40.243(f))
 Require employee to provide positive identification
 If EBT does not print results on paper strip: Did the BAT
(Part 40.61(c)).
complete the following information on Step 3 of the ATF
 Direct the employee to remove outer clothing (jacket,
hat) and to leave these garments and other personal
Identification of the machine
items (briefcase, purse, etc.) in a mutually agreeable
location (Part 40.61(f)).
Sequential Test Number
- Advises employee that failure to comply
Test Outcome
constitutes a refusal to test.
 Complete Step 3 of the ATF by dating and signing the
- Allows employee to keep wallet (40.61(f)(2)).
certification (40.247(a))
 Direct employee to empty pockets and display items
 Distribute the ATF copies to appropriate individuals
in them (Part 40.61(f)(4)).
- If no potential adulterants are found, allow
− Copy 1 to Employer
employee to return items to pockets.
− Copy 2 to Employee
 Complete Step 1 of CCF (Part 40.63(a)).
− Retain Copy 3
- Ensures that the name and address of the drug
After the Breath Alcohol Test is completed, review the
testing laboratory appears at the top of the CCF.
following items:
- Ensures that the Specimen ID at the top of the
 Was consent - giving the collection site or its personnel
CCF matches the Specimen ID on labels/seals.
indemnification - required for testing? (40.355(a))
- Checks the Reason for Test box (Pre-
− Collection sites cannot require an employee to sign a
Employment, Random, Post-Accident, etc.).
consent, release, waiver of liability, or indemnification
- Checks the DOT and the FTA box (Testing Authority)
agreement with respect to any part of the alcohol or
- Checks the Drug Tests to Be Performed box
drug testing process covered by 49 CFR Part 40. No
one may do so on behalf of a service agent
 Instruct employee to wash/dry hands and not to
 Is the EBT on the National Highway Traffic Safety
wash hands again until delivering specimen to
Administration (NHTSA) conforming products list?
collector (Part 40.63(b)).
 Was the correct ATF used? (40.225(a))
 Ensure collection container is selected and
− The DOT ATF must be used for every DOT alcohol
unwrapped in presence of employee (Part 40.63(c)).
test. The ATF must be a three-part carbonless
manifold form. The ATF is found in Appendix G of


00 votes

Related Articles

Related forms

Related Categories

Parent category: Life
Page of 2