Clearinghouse Reporting

Name: Clearinghouse Reporting
SKU: 3272
Price: 10.00 USD
Availability: InStock

$10.00

Employer reportable violations include positive alcohol tests, refusals to test, and actual knowledge of drug or alcohol use while operating a Commercial Motor Vehicle. After a violation, some steps of the Return to Duty Process reported to the FMCSA Clearinghouse are also the responsibility of the Employer.

**Comprehensive Drug Screening & DOT Compliance Services will need to be designated as your third-party administrator to provide this service.

Type of Employer Report*

Employer Name*

Address*

USDOT #

Phone*

Email*

Driver Name*

Driver Date of Birth*

CDL #*

State of Issue*

Country of Issue*

Date of Alcohol Test

Reason For Test

Test Result

Documentation

Accepted file types: pdf, docx, Max. file size: 5 MB.

Date of Test

Test Type

Reason For Test

Documentation of the Refusal

Upload Documentation
Accepted file types: pdf, docx, Max. file size: 5 MB.

Test Type

Specimen ID #

Date of Test

Reason For Test

Test Result

Date of Verified Result*

Documentation

Accepted file types: pdf, docx, Max. file size: 5 MB.

Date Drivers Follow up Plan has Been Successfully Completed

Documentation

Accepted file types: pdf, docx, Max. file size: 5 MB.

Date Employer Obtained Actual Knowledge: (date field)

Description of the violation:

Witnesses to the violation, include any contact information

Accepted file types: pdf, docx, Max. file size: 5 MB.

Evidence supporting each fact alleged in the description of the violation

Max. file size: 5 MB.
Evidence supporting each fact alleged in the description of the violation, which may include, but is not limited to, affidavits, photographs, video or audio recordings, employee statements (other than admissions pursuant to § 382.121), correspondence, or other documentation.

A certificate of service or other evidence showing that the employer provided the employee with all information reported.

Accepted file types: pdf, docx, Max. file size: 5 MB.

Please fill out and submit form before clicking Add to cart.

Category: FMCSA Clearinghouse Support

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Clearinghouse Reporting

Type of Employer Report*

Address*

Driver Name*

Reviews

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Clearinghouse Reporting

Type of Employer Report* Alcohol Test ViolationEmployer Determined Refusal to Test (Drugs or Alcohol)Return to Duty (RTD) Negative Test Results:Completion of Follow-up Testing PlanActual Knowledge of Drug or Alcohol Use

Address*

Driver Name*

Reviews

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Type of Employer Report*