• Return to Duty and Consortium Third Party Administrator Consent Form

    Thank you for allowing TSN Mobile Lab Solutions to support your FMCSA Clearinghouse compliance needs.
    Return to Duty and Consortium Third Party Administrator Consent Form

  • Here are a few reminders before starting our services:


    1. You have to have a checkmark in step 1-4 in the FMCSA Drug and Alcohol Clearinghouse BEFORE we can work with you.
    2. If you need a SAP visit, please ask us for a list of reputable SAPS we have worked with in the past to ease your selection process.
    3. When you get a checkmark in step 1-4 in the Clearinghouse we can then be your Consortium/Third Party Administrator and send you to take the return to duty drug screen. Please complete the information below and agree to the terms and conditions.

    4. After you fill out this form and submit your payment a member of our team will:

    • Request your final eval report & follow-up testing plan from your SAP.
    • Call you from (254) 589-1746 to walk you through designating us as your C/TPA in the Clearinghouse.
    • Create your donor pass for you to take to the drug testing lab to get tested.

    Have questions before you get started? Contact a member of our team anytime @ (254) 589-1746.

    Thanks and we look forward to working with you!

    TSN MOBILE LAB SOLUTIONS
    contact@tsnmoblabsol1.com

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    • Testing & Scheduling Details 
    • Secure Your Spot 

    • Choose your payment option below to begin your RTD Step 5 process.

    • Split payment allows you to start today. Final balance must be paid before results and documentation are released.

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    • By submitting this application I affirm that I am the person, submitting the requested information and that the information entered is true and correct.

      I also affirm that I agree and understand the following: I hereby provide consent to TSN Mobile Lab Solutions to act as my Consortium/Third Party Administrator in the FMCSA Drug and Alcohol Clearinghouse. I understand that they will conduct a before and after query(full) of my Clearinghouse record.

      I understand that this consent shall remain on file and shall serve as ongoing consent for TSN Mobile Lab Solutions to conduct full Consortium/Third Party Administrator services on my behalf and perform the necessary return-to-duty testing, reporting and document management on behalf of my company. I understand that to complete this service, I will be registering in the Clearinghouse as an Owner Operator.

      I understand that if I refuse to provide consent for TSN Mobile Lab Solutions to conduct a query of the Clearinghouse, I will not be able to proceed in the steps for clearing step 5 in the return to duty process.

      I understand that I if I am not an owner operator with an active DOT number that the FMCSA allows a Consortium/Third Party Administrator to perform step 5 (Get out of Prohibited Status) ONLY. Furthermore, I understand that step 6 must be completed with an employer and while performing safety-sensitive functions.

      In addition, I authorize the release of my confidential health information about me from my Substance Abuse Counselor to include my initial assessment, treatment plan, successful completion and follow-up testing plan, by releasing a copy of my medical record, or a summary or narrative of my protected health information to be sent to:

      Attn: TSN Mobile Lab Solutions

      C/TPA Primary Contact: Tiffany Harris

      Phone: 254-589-1746

      Email: contact@tsnmoblabsol1.com 

      The goal of the FMCSA RTD process is to ensure the safety of the motorist on the roadways. If you fail, refuse or receive an actual knowledge violation at any point during the process of completing the return-to-duty drug test, you will be required to start the process over.

       Do not start the process if you are at risk of failing the return-to-duty drug test. I understand that if I receive a POSITIVE Return to Duty test, I will have to start the process again and will not be able to perform safety-sensitive functions.I understand that all sales are final. There are no refunds, cancellations or transfers allowed.

       We Reserve the RIGHT TO REFUSE to work with anyone. Again, I understand that all sales are final, non-cancellable, non-transferable.

       
      Disclosure Regarding Disputes and Chargebacks

      By engaging our services, clients acknowledge and agree to our comprehensive refund policy and understand that all sales are final, non-refundable, and non-transferable. In the event of a dispute or chargeback, please be advised that we maintain detailed records, including initial signed contracts, drug test results, email communications and all associated information pertinent to the services rendered. These records are retained to protect our company against chargebacks and disputes.

      Charges shown on your credit card/bank statement may appear as TSN Mobile Lab Solutions, LLC.

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