RTD Testing Driver Information Form

RTD Testing Driver Information Form

www.DriveLineCompliance.com
IMPORTANT:

If you or your carrier have not completed your payment yet, your account will not be active.

Please go here to make your payment and you will recive an email to get started once completed: Order RTD Test Here

If you or your carrier have already made your payment, please continue with this form.
How did you hear about us?*
How did you hear about us?
IMPORTANT NOTICES

The cost of the Drug Test is included in both Step 5 & Step 6 Pricing, however, these are extra expenses to prepare for:

Step 5: $2.50 | You will need to purchase (2) Clearinghouse Queries

Steps 5 & 6: $65.00 | Alcohol Test

(Only if the driver is required by their SAP Counselor to do both Drug and Alcohol Testing. This will be billed to the driver before the test is scheduled)

STEP 5 RETURN TO DUTY TESTING & REPORTING | $150.00

Includes:
- Cost of First Drug Test
- Full management of your RTD Testing Process
- Scheduling of required drug and/or alcohol tests
- Submission of results to FMCSA Clearinghouse
- Secure file storage & compliance support for 5 years
- Unlimited Record forwarding to future employers upon request
STEP 6 FOLLOW-UP TESTING MANAGEMENT | $165.00

IMPORTANT NOTE FOR DRIVERS! FMCSA Requires drivers to be working under a carrier before they can start Step 6.

If you are not a True Owner Operator, DriveLine can sign you on with a SAP Friendly Carrier or we can do your tests under your current carrier if they are not taking care of them for you. No cost to the carrier at all.

This service allows drivers to pay for their own tests and help make sure they are getting done.

Includes:
- Cost of First Drug Test
- Enrollment in our Drug & Alcohol Consortium
- Full management of your SAP Follow-Up Testing Plan (Step 6)
- Scheduling of required drug and/or alcohol tests
- Submission of results to FMCSA Clearinghouse (Under Your Carrier)
- Secure file storage & compliance support for 5 years
- Unlimited Record forwarding to future employers upon request
Please Note:

1) We will schedule the test as close to your preferred zip code as possible but we cannot schedule the screening at any personally preferred location. Unfortunately we are not able to work with just any facility, we must use the ones in our network that we are currently set up with.

2) Male medical staff to assist in observed testing has been in a shortage. If the facility does not have a person on staff that can assist in conducting the Observed testing, please ask them if you can schedule to come back when one is available soon. If they can't, please reach out to us to us and we will schedule at a different facility.

3) Alcohol testing is not available at every facility. Your screening may be booked at a location further from you than expected if your SAP Counselor requires you to complete both Drug & Alcohol tests.

4) Alcohol Test, if required will be an extra $65.00 for Steps 5 or 6 (Only if the driver is required by their SAP Counselor to do both Drug and Alcohol Testing. This will be billed to the driver before the test is scheduled)

Driver Information
Driver Name: (As Shown in Your Clearinghouse Account)*

First NameLast Name
Driver Email:*
Be sure to double check that email is correct.
Phone Number:*
Please enter a valid phone number.
Date of Birth:*
Last 4 of Social Security Number:*
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Need to take the DT in a different location away from your home address?
Zip Code of alternate location
CDL Information
CDL Number:*
Be sure to double check that CDL # is correct.
CDL Issue State*
Male / Female*
(Observed Tests Require Same Sex Staff to Observe)
Upload Front of CDL*

Cancelof
Join the Track My SAP Waitlist

Completely Free Service for 1 year. No Credit Card Required to sign up. Only to renew after 1 year if you need to.

www.TrackMySAP.com
FMCSA / Clearinghouse Information
IMPORTANT

THIS IS HOW WE WILL KNOW WHICH ACCOUNT IS YOURS IN CLEARINGHOUSE SO THE NAME MUST MATCH WHAT IS ON THIS FORM.

You must create a company name when you create a new employer clearinghouse account.

Please enter the name you will use here so we can approve your request.
COMPANY NAME | EMPLOYER ACCOUNT*
You can just use your first and last name EXAMPLE John Wayne Trucking
Do you have a DOT #?*
No DOT is needed for the Return to Duty Test | Only needed if you plan to do your Follow-Up Testing with DriveLine
DOT#*
SAP Counselor's Information
SAP Counselor's Name:*
SAP Counselor's Phone Number:*
Please enter a valid phone number.
SAP Counselor's Email:*
example@example.com

Authorization to Release SAP Completion Documents
The documents to be released are described or listed as: Behavioral Health & Treatment Records

The records are required for the specific purpose of: Return to Duty Testing

I understand that my authorization will remain effective from the date of my signature until client termination unless otherwise dated and that the information will be handled confidentially in compliance with all applicable federal laws.

I understand that I may see the information to be sent and may revoke the authorization at any time by written, dated communication.
I have read and understood the nature of this release form:*

Clear
Date*

MonthDayYear
Date
If paying with someone else's card please enter their name here:
Should be Empty:

RTD Testing Driver Information Form

Driver Information

CDL Information

FMCSA / Clearinghouse Information

SAP Counselor's Information

Authorization to Release SAP Completion Documents