Appendix D to Part 40 - Report Format: Split Specimen Failure To Reconfirm
49:1.0.1.1.30.20.43.1.31 : 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, W62-300, 1200 New Jersey Avenue SE.,
Washington, DC 20590,
Fax: (202) 366-3897. Submit
Electronically:
https://www.transportation.gov/content/split-specimen-cancellation-notification-49-cfr-part-40187-appendix-d
The following items are required on each report:
1. MRO name, address, phone number, and fax number.
2. Collection site name, address, and phone number.
3. Date of collection.
4. Specimen I.D. number.
5. Laboratory accession number.
6. Primary specimen laboratory name, address, and phone
number.
7. Date result reported or certified by primary laboratory.
8. Split specimen laboratory name, address, and phone
number.
9. Date split specimen result reported or certified by split
specimen laboratory.
10. Primary specimen results (e.g., name of drug,
adulterant) in the primary specimen.
11. Reason for split specimen failure-to-reconfirm result
(e.g., drug or adulterant not present, specimen invalid,
split not collected, insufficient volume).
12. Actions taken by the MRO (e.g., notified employer of
failure to reconfirm and requirement for recollection).
13. Additional information explaining the reason for
cancellation.
14. Name of individual submitting the report (if not the
MRO)
[82 FR 52247, Nov. 13, 2017]