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Appendix C to Part 40-DOT

Mail, fax, or email to:

U.S. Department of Transportation

Office of Drug and Alcohol Policy and Compliance

W62-300

1200 New Jersey Avenue, S.E.

Washington, DC 20590

Fax: (202) 366-3897

Email: ODAPCWebMail@dot.gov

The following items are required on each report:

Reporting Period: (inclusive dates)

Laboratory Identification: (name and address)

1. DOT Specimen Results Reported (total number)

2. Negative Results Reported (total number)

Negative (number)

Negative-Dilute (number)

3. Rejected for Testing Results Reported (total number) - By Reason

(a) Fatal flaw (number)

(b) Uncorrected Flaw (number)

4. Positive Results Reported (total number) - By Drug

(a) Marijuana Metabolite (number)

(b) Cocaine Metabolite (number)

(c) Opiates (number)

(1) Codeine (number)

(2) Morphine (number)

(3) 6AM (number)

(d) Phencyclidine (number)

(e) Amphetamines (number)

(1) Amphetamine (number)

(2) Methamphetamine (number)

(3) MDMA (number)

(4) MDA (number)

(5) MDEA (number)

5. Adulterated Results Reported (total number) - By Reason (number)

6. Substituted Results Reported (total number)

7. Invalid Results Reported (total number) - By Reason (number)

[73 FR 35975, June 25, 2008, as amended 75 FR 49864, August 16, 2010]

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