DONOR’S NAME:
COMPANY NAME:
REQUESTING PERSON:
THIS PERSON WILL REPORT FOR TESTING NO LATER THAN (Date & Time):
(We recommend that testing be done immediately, with no more than 30 minutes notice-This will dramatically reduce dilute samples)
 
*** PLEASE SELECT THE TEST YOU WOULD LIKE CAL-TEST TO PERFORM ***
If no test is selected, Cal-Test will default to our Comprehensive 9 Panel Test
COMPANY POLICY TESTING:
COMPREHENSIVE Lab Based Urine Drug Test – 9 Drugs
LAB BASED Urine Drug Test – 5 Drugs
INSTANT Urine Drug Screen - 10 Drugs (No GC/MS)
INSTANT Urine Drug Screen - 5 Drugs (No GC/MS)
BREATH ALCOHOL Screen, with confirmation
COLLECTION ONLY, using our lab forms
HAIR TESTING Lab Based HAIR testing – 6 Panel
* GC/MS or MRO available for an additional $ 25.00 each, if needed.

D.O.T. Mandated Testing: (Title 49 CFR Part 40)
D.O.T Urine Drug Test – FEDERAL LAB  
BOTH Drug AND Breath Alcohol 
What Location will this Driver Work?
 
TEST TYPE: Pre-Employment      Random      Accident      Cause      RTD/Follow-Up
COLLECTION SITE DESIRED (“Network Site”):