DRUG AND ALCOHOL TESTING CHECKLIST

Instructions: This checklist covers both drug and alcohol testing procedures. For drug
testing only, complete Sections I and II. For alcohol testing, complete Sections I and III.
Whenever feasible, read through the checklist completely before submitting to testing(s)
so that you fully understand the testing procedures and to know your rights. Do not
provide a copy to management.

After completing the checklist, please provide a copy to your FACREP or your
designated Union Representative as soon as possible. Feel free to attach additional
paper to explain the circumstances you may have encountered.

Be aware of the following points:

 Article 73 of the CBA covers substance testing.

 DOT Order 3910.1C, and 3910.1C Testing Guide, are the FAA’s implementing
regulations on drug and alcohol testing.
 Always request Union Representative during testing.
 If a Union Representative is not with you during testing, find out who the designated Site
Coordinator (SC) (or the Drug Program Coordinator) is responsible for administering the
testing process. Direct any questions or concerns about testing to the SC (if you don’t
have Union Representation during testing).

Name: __________________________ Date: _______________________

Your contact information (phone, email): _____________________________

Facility: _____________ Union Rep: ______________________________

Name of Collector (if known) ____________________ Alcohol ___ Drug ___ Both __

Random ___ Post-Accident ___ Reasonable Suspicion ____ Follow-Up __ Return to Duty ___

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 Section I

1 Were you informed in a private and confidential manner that you would be tested? Yes/No
2 Were you informed as to the time and the exact location to report for testing, and Yes/No
instructed to take with you photo identification?
3 Did you request a Union Representative? Yes/No
4 If you requested a Union Representative, was one provided? Yes/No
5 If no, describe why you were not afforded a union representative.

6 If yes, was your union representative permitted to observe the collection process? Yes/No
7 If not, describe why this did not occur?

8 Were you asked by the collector/BAT for your photo ID? Yes/No
9 Did you show your photo ID? Yes/No
10 If no, what did the collector/BAT do?1 Yes/No
11 Was the SC present at the test site, or was the SC readily available? Yes/No
12 Was there anyone other than the collector/BAT, the SC and/or the Union Rep Yes/No
present during testing?
13 If yes, who else was there?

14 Did the Agency use your SS# as your employee test number? Yes/No
15 Did you request that the Agency NOT use your SS#?2 Yes/No
16 Did the Agency comply with your request to NOT use your SS#? Yes/No

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If the donor does not have a photo ID, the collector/BAT will note on the Control Form. The
collector/BAT notifies the DPC/SC to obtain further guidance. The DPC/SC contacts the
employee’s supervisor to confirm identification. NATCA recommends you always produce a
photo ID.
2
BUE should always request that the SS# not be used.

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17 If post-accident or reasonable suspicion testing, were you provided a letter Yes/No
explaining the reasons for such testing to take place?
SECTION II - DRUG TESTING
Yes/No
18 Were you asked to remove outer garments (i.e., coats, jackets) and to empty your Yes/No
pockets?
19 Were you instructed to wash your hands? Yes/No
20 Did the collector/BAT observe you (or was present) during you washing your hands? Yes/No
21 After washing your hands, was the collector with you at all times? Yes/No
22 Was the toilet-bluing agent placed in the toilet bowl? Yes/No
23 Did you observe an individually wrapped disposable urine collection cup open in Yes/No
your presence?
24 Were you afforded privacy of a stall or otherwise partitioned area that allowed for Yes/No
individual privacy?3
25 For drug testing, was the collector of the same gender? Yes/No
26 Did you provide at least 45 ml of urine sample? Yes/No
27 If no, describe what you were instructed/required to do.

28 Did the collector check the temperature of the specimen? Yes/No

29 Were you asked to observe the reading of the temperature and the recording of it on Yes/No
the Control Form?
30 Were you permitted to wash your hands after the specimen was provided? Yes/No
31 Did you observe the collector split your sample into two bottles and produce a Bottle Yes/No
A and a Bottle B?
32 Did you observe the collector label the two bottles into Bottle A and Bottle B? Yes/No
33 Did you observe the collector seal the bottles with a temper proof seal over the two Yes/No
bottles?
34 Did the sealed bottles contain an identification number along with a bar code? Yes/No
35 Did you observe any unattended and/or unsealed collection cups or specimen cups Yes/No
other than your?
36 Did the collector date the specimen bottle seal(s) and ask you to initial the sealed Yes/No
labels on the bottles?
37 Were the specimen in the collector’s and your view at all times until it was packaged Yes/No
and sealed?
38 Did the collector who began your paperwork turn the collection process over to Yes/No
another collector at any point during the collection?
39 If yes, was the transfer noted on the Control Form? Yes/No
40 Was the restroom secure during the entire collection process? Yes/No
3
Under routine random drug testing, the Order requires for individual privacy while the
employee provides a sample. Director observation collection would occur if there is evidence of
the employee tampering with the donation process.

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41 Were you permitted to confer with your Union Rep at least 10 minutes prior to the Yes/No
collection and 10 minutes after the collection?
42 If not, explain why this did not occur.

43 Specify any other unusual or abnormal circumstances that occurred during your
collection.

Section III – ALCOHOL TESTING

44 Was the SC in the collection area? Yes/No

45 If not, was the SC readily available? Yes/No
46 Did anyone other than BAT have access to the EBT equipment? Yes/No
47 If yes, who (if you recall).

48 Did you request a union representative? Yes/No

49 Was one afforded to you? Yes/No
50 Did you have at least 10 minutes to confer with your rep before and after the Yes/No
testing?
51 Before the screen test was administered, were you asked if you had consumed any Yes/No
food or drink, or smoked in the past 15 minutes?
52 Did you consume any food or drink, or smoked in the 20 minutes prior to taking the Yes/No
screen test?
53 Before the BAT administered the screen test, did he/she conduct an Air Blank test? Yes/No
54 Did it register at 0.00?4 Yes/No
55 If no, what was the Air Blank test result (if known)?

56 Were you afforded with visual and aural privacy at the testing site? Yes/No
57 Was the testing area secure? Yes/No

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If the first Air Blank test fails, the BAT will proceed with the second Air Blank test. If the
second test also fails to register at 0.00, the EBT will be taken out of commission, and cannot
proceed with testing. The Agency, however, may proceed with another EBT equipment.

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58 If no, explain.

59 Did you ever observe the BAT leave the testing site while preparing for a testing or Yes/No
while testing of an employee was in progress?
60 Was an individually sealed mouthpiece open in view of you? Yes/No
61 Did you observe the BAT attach the mouthpiece to the EBT equipment? Yes/No
62 Were you instructed to blow forcefully into the mouthpiece for at least 6 seconds or Yes/No
until the EBT indicates that an adequate amount of breath has been obtained?
63 Did the BAT show you your result? Yes/No
64 Did the BAT affix the test result printout to the Control Form in the designated space Yes/No
by using a temper-evident tape?
65 Did the BAT show you the test printout? Yes/No
66 Did you walk away with your copy of the Control Form what showed the test result Yes/No
printout?
67 If not, explain why not.

68 Did you encounter a situation where the EBT result did not match the printout Yes/No
result?
69 If yes, explain how the BAT/the Agency handled the situation.

70 Did you have a confirmation test of 0.02 or higher? Yes/No

71 Did the BAT wait at least 15 minutes before administering the Confirmation test? Yes/No
72 Did the BAT explain not to eat, drink, smoke, put any substance in the mouth, or Yes/No
belch during the waiting period before administering the Confirmation test?
73 Did the BAT insert a different individually sealed mouthpiece into the EBT? Yes/No
74 Did the BAT conduct an Air Blank check before administering Confirmation test? Yes/No
75 Did it register 0.00 during the Air Blank check? Yes/No
76 Did the BAT show you the test result displayed on the EBT? Yes/No
77 Did the BAT affix the test result printout to the Control Form with a tamper-evident Yes/No
tape?
79 Does the Control Form show both the Screen and Confirmation test printouts? Yes/No
80 Did the Confirmation test result displayed on the EBT differ from the printout result?5 Yes/No

81 If yes, explain what the Agency did because of the disparity.

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If the EBT result and the printout result do not match, the test is invalidated, and the SC and the
BUE is advised on the invalid test.

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82 If you tested between 0.02 and 0.039, what happened to you for the remainder of
the shift?

83 Specify any other unusual or abnormal circumstances that occurred during the
collection process.