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DOT Drug and Alcohol
Program Requirements |
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DOT/PHMSA reporting
forms and requirement information |
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Step 1
~
Anti-Drug Program & Alcohol Misuse Prevention Program |
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If your company does
not already have a DOT drug and alcohol program, you can obtain
the services of a Third Party Administrator (TPA) or a
Consortium. A TPA will help insure all Federal Regulations are
met as changes occur. If you are interested in obtaining the
services of a TPA, please contact Bridget Schmidt at
620.669.4412 or Tricia Radke at 620.669.4423
for more information. |
Step 2 ~
DOT/PHMSA Contractor Audit Request Form
[Download]
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Fill
in your basic company information and use this as a checklist
for all items that are required to be sent to NCMS. |
Step 3 ~
COVERED EMPLOYEE LIST
PHMSA
NOTE: [Download]
DEFINITIONS:
[Download]
COVERED EMPLOYEE LIST
[Download]
FMCSA
NOTE:
[Download]
DEFINITIONS:
[Download]
COVERED EMPLOYEE LIST
[Download]
FAA
NOTE:
[Download]
DEFINITIONS:
[Download]
COVERED EMPLOYEE LIST
[Download]
USCG
NOTE: [Download]
DEFINITIONS:
[Download]
COVERED EMPLOYEE LIST
[Download]
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Any
individual who could or would perform an operation, maintenance,
or emergency-response function on an operator’s pipeline and
that function is subject to the Federal pipeline regulations as
stipulated in 49 CFR Parts 191, 192, 193, or 195. Such functions
as performing clerical, payroll, and administrative duties are
not considered as performing a pipeline function and would not
subject the employees to drug testing.
Click here to see a List
of Covered Functions
GUIDANCE:
Fill out the Covered Employee List (If you currently do not have
a DOT compliant program in place you must test all employee's
who may perform DOT work with a DOT pre-employment drug test,
and the result must be negative before the employee is put into
the random testing pool) On the Covered Employee List, include
the employee's name, job title, and the date that the employee
was drug tested. All employee's who may perform DOT work should
be included in the pool and therefore, included on the Covered
Employee List |
Step 4 ~ SUPR
TRAINING
DOT Supervisor Training Definition
[Download]
DOT Supervisor Training Listing
[Download]
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Each
contractor shall conduct 1 hour of drug and 1 hour of alcohol
training for each supervisor who may be involved in making
determinations with regard to requiring any employee to submit
to reasonable cause drug testing or reasonable suspicion alcohol
testing.
GUIDANCE: Fill out the Supervisor Training list
with the supervisor's name, and date the 1 hour of drug and 1
hour of alcohol training was received. |
Step 5 ~
STAT DATA REPORTS
PHMSA Instructions
[Download]
PHMSA Note [Download]
PHMSA Statistical Data Reporting Form
[Download]
FMCSA Instructions
[Download]
FMCSA Note
[Download]
FMCSA Statistical Data Reporting Form
[Download]
USCG Instructions
[Download]
USCG Note [Download]
USCG Statistical Data Reporting Form
[Download]
FAA Instructions
[Download]
FAA Note [Download]
FAA Statistical Data Reporting Form
[Download]
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POPULAR DOWNLOAD!!!! The submission of the Quarterly Statistical
Data Report is the KEY to demonstrating your company's
compliance with the random testing as required in the Federal
Regulations.
PHMSA -
Instruction - This sheet provides instructions on how to
complete the PHMSA (Pipeline) statistical data report.
FMCSA -
Instruction -
This sheet provides instructions on how to compete the FMCSA
(Drivers) statistical data report.
USCG - Instruction - This sheet provides instructions on how to
compete the USCG statistical data report.
FAA - Instruction -
This sheet provides instructions on how to compete the FAA
statistical data report.
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Step 6 ~
DOT CUSTODY & CONTROL FORM
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Obtain a COPY (BLANK) Federal Custody & Control Form from your TPA or
your collection site and submit it to NCMS for your file.
GUIDANCE:
Insure that all tests that are performed on behalf of your
Federal DOT testing program are performed on a Federal Testing
form. |
Extra ~
(Operators Only)
Spot Check Form [Download]
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The "Spot" check
form is a procedure whereby an operator can determine if the
contractor employees on their pipeline property or facilities
have been pre-employment drug tested under the DOT regulations
and the employees are listed in the contractor's random testing
pool.
GUIDANCE:
Please print out the "Spot" check form and the "instruction"
page and follow the procedures outlined for conducting the spot
check and the review process by NCMS. |
Extra ~
Covered Functions [Download]
Covered Function Guidelines [Download]
Background Check
Affidavit Form
[Download]
B-C Form
[Download] |
Covered Functions Criteria: The information provides guidance
on what functions performed by a contractor are considered as
performing a "Covered Functions" under the PHMSA pipeline
regulations. There is a list of covered functions; functions
which may not be covered functions; and a listing of functions
which may require additional guidance as to whether they are
covered or not considered as covered. There is also information
on "Emergency Response" contractor information.
GUIDANCE: Pipeline
operators may want to review this information to determine if a
particular function that is to be performed by a contractor
would be considered as performing a "Covered Function" and thus
would subject the contractor to have in place a DOT pipeline
drug/alcohol program that address all the regulations under the
Pipeline and Hazardous Materials Safety Administration, 49 CFR Part 199
and the Department of Transportation, 49 CFR Part 40
regulations. |
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Contractor
Package
The attached package of correspondence and forms are to be completed
by each contractor and forwarded to NCMS for evaluation to determine
the contractor's compliance with the pipeline drug/alcohol testing
regulations. All files must be downloaded and completed before
submitting to NCMS.
PHMSA Contractor Packet
NEED TO SUBMIT
- FMCSA (CDL Holders that could perform Pipeline Functions) If
Applicable to Your Company
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The items
above may be filled out and e-mailed to
tricia@nationalcompliance.com or mail entire package to:
NCMS (DOT Audit) - 7 Compound Drive - Hutchinson, KS 67502.
All files are saved in ZIP
format.
Click here if you need to
download Winzip |
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