MRO/TPA Drug Test Results Report Checklist
The MRO may use a signed or stamped and dated legible photocopy of Copy 2 of the CCF to report test results. If the MRO does not report test results using Copy 2 of the CCF, he or she must provide a written report for each test result.
This report must, as a minimum, include the following information:
- MRO name, address, and phone number
- The name of any person other than the MRO reporting the results (if applicable)
- Full name, as indicated on the CCF, of the employee tested
- Donor SSN or employee ID number
- Specimen ID number from the CCF
- The DOT agency, if noted on the CCF
- Reason for the test (e.g., random, post-accident), if indicated on the CCF
- Date of the collection
- Date the MRO received Copy 2 of the CCF
- Result of the test (i.e., positive, negative, dilute, refusal to test, test cancelled) and the date the result was verified by the MRO
- For verified positive tests, the drug(s)/metabolite(s) for which the test was positive (should not include quantitative values for drugs found)
- For cancelled tests, the reason for cancellation
- For refusals to test, the reason for the refusal determination
