• Designed for use when testing employees not regulated by DOT; based on the form used for regulated employees
• Snap-out format
• Three plies
• Carbonless
• Measures 8-1/2" W x 11-3/4" L
• Imprinting available. Call toll-free for pricing.

Please note:
As of 3/13 this form no longer features a Random Alcohol Testing section. Under the Americans with Disabilities Act, as amended (ADA), alcohol tests are considered medical exams. The ADA restricts when employers may require employees to undergo medical exams. To do so must be job related and consistent with business necessity. To meet this "job related…" provision, the request must, in part, be made to a particular employee. Since random tests do not focus on a particular employee, they do not meet this provision. Therefore, they risk violating the ADA.

To help avoid confusion and to help employers from inadvertently violating ADA, we have removed that section from this form.

View Sample

View a sample Alcohol Testing Form - Non-DOT Format.