Implementation Guidelines - Federal Transit Administration - U.S. ...

URINE COLLECTION QUESTIONNAIRE
Was the employee required to sign a consent form?
Upon the employee’s arrival at the collection site, does the collector positively identify the
individual by photo identification?
If the employee is also going to take a DOT drug test, was the alcohol test administered first?
Does the collector ask the individual to remove any unnecessary outer garments that could
conceal items for use in adulterating a specimen and ensure that personal items such as
purses and briefcases remain with outer garments?
Does the collector direct the employee to empty his or her pockets and display the items in
them to ensure that there are no items present that could be used to adulterate the
specimen?
Is the employee allowed to keep his/her wallet?
Does the collector explain the basic collection procedure to the employee and/or show the
employee the instructions on the back of the CCF?
After the employee is asked to remove outer clothing and empty pockets, is the employee
instructed to wash and dry his/her hands?
Is there a source of water for hand washing, which if practicable, should be external to the
privacy enclosure?
Is the employee then provided with a single-use collection container or a specimen bottle
capable of holding at least 55 milliliters of urine?
Are collection containers sealed, and does the employee or collector remove the sealer
wrapper in the presence of employee?
Do the specimen bottles have a tamper-evident seal to preclude undetected opening, a
means to affix a unique identifying number identical to that appearing on the CCF, and
provision for initialing by the employee to affirm the identify of the specimen?
Is the employee then required to remain in the presence of the collector (with no access to
water, soap, or other adulterating agents) until entering the privacy enclosure to provide the
specimen?
Is there a privacy enclosure for urination, in which all sources of clear water have been
eliminated, possible specimen contaminants have been removed, and all places where
paraphernalia could be hidden have been secured or removed?
If a non-dedicated facility (public restroom or hospital examining room) is used for collections,
is that portion used for testing secured during drug testing by: 1) visually inspecting the
privacy enclosure; 2) assuring that undetected access (e.g., through a rear door) is
prevented; and 3) POSTING THE FACILITY AGAINST UNAUTHORIZED ACCESS?
Are there always bluing agents in toilet tanks to preclude diluting of the specimen?
To the maximum extent possible, do collection site personnel keep the individual's specimen
bottle within sight before and after the individual has urinated?
Does the collector then determine that the specimen quantity is at least 45 milliliters?
Using the temperature strip attached to the collection container, does the collector determine
within 4 minutes that the temperature is within the range of 32°-38°C/90°-100°F?
Are the two specimen bottles sealed until it is time to pour the sample from the collection
container?
After specimen collection and temperature reading, does the collector pour at least 30 ml of
urine into the primary specimen bottle?
Is at least 15 milliliters of the remaining specimen poured into the second container, to be
used as the split specimen?
Is there a suitable clean surface for writing?
Appendix K. Substance Abuse Management Oversight Questionnaires
K-16
August 2002