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Sample Forms & Policies

The samples listed below are intended to help an employer or contractor meet the FAA's drug and alcohol testing program requirements. You are not required to use the sample forms and policies, and you may edit them to fit your needs.

If you have questions about the sample forms and policies, or recommend we add something new, please contact us at (202) 267-8442 or email us.

Program Implementation and Maintenance
Title Description
Sample Drug and Alcohol Program Registration (PDF) Use this sample form to register your testing program with the Drug Abatement Division. You can also use it to renew or amend your registration. For more information on whether you need to register, review How To Start A Program.
Sample Drug and Alcohol Policy and Posting Samples Visit this web page for a sample drug and alcohol testing policy and sample bulletin board postings.
Sample Drug and Alcohol Program Registration (MS Word) Use this sample form to notify an employee of their random selection and requirement to report immediately for testing.
Reasonable Cause/Reasonable Suspicion Documentation Form (PDF) Use this sample form to document a determination to conduct reasonable cause/reasonable suspicion testing.
Evidential Breath Testing Device Calibration Log Book (MS Word) Use this sample log book to document proper calibration of your Evidential Breath Testing (EBT) device(s).
Management Information System (MIS) Information Visit this web site for more information on the requirement to submit an annual MIS report.
Hiring Forms
Title Description
Checklist: New Hire/Transfer for Safety-Sensitive Position (PDF) Use this sample checklist to ensure you complete all necessary steps when hiring an individual for or transferring an employee into a safety-sensitive position.
Pre-employment Notification and Acknowledgement Form (MS Word) Use this sample form to notify an individual of their requirement to submit to a pre-employment drug test before they are hired or transferred into a safety-sensitive position.
Release of Information Form - Suggested Format (MS Word) Use this suggested form to obtain authorization for the release of drug and alcohol testing records from a new safety-sensitive employee, and to request the employee's drug and alcohol testing records from a previous DOT-regulated employer.
Release of Information Form - Form 8060-12 (Pilots Only - PRIA) (PDF) When hiring a pilot, use this suggested form to obtain authorization for the release of drug and alcohol testing records, and to request the pilot's drug and alcohol testing records from a previous DOT-regulated employer. For help using this form or for questions regarding the Pilot Records Improvement Act of 1996 (PRIA), visit the PRIA web site and review the Overview and Use of Form 8060-12 (MS Word) document.
Employee Violation Forms
Title Description
Checklist: Steps to Take After an Employee Violates Drug/Alcohol Testing Regulations (PDF) Use this sample checklist to ensure you have taken all required steps after an employee violates the drug and alcohol testing regulations.
Report a Verified Positive Drug Test - Part 67 Airman Medical Certificate Holder (PDF) Use this sample reporting form to inform the Drug Abatement Division of a verified positive drug test by a part 67 medical certificate holder. You must report all violations by an individual that holds a part 67 certificate to the FAA within 2 working days after the violation.
Report a Verified Positive Drug Test - Employees other than Part 67 Certificate Holders (PDF) Use this sample reporting form to inform the Drug Abatement Division of a verified positive drug test by an employee who does not hold a part 67 medical certificate.
Report Prohibited Alcohol-Related Conduct - Part 67 Airman Medical Certificate Holder (PDF) Use this sample reporting form to inform the Drug Abatement Division of prohibited alcohol-related conduct by a part 67 medical certificate holder. You must report all violations by an individual that holds a part 67 certificate to the FAA within 2 working days after the violation.
Report Prohibited Alcohol-Related Conduct - Employees other than Part 67 Airmen Medical Certificate Holders (PDF) Use this sample reporting form to inform the Drug Abatement Division of prohibited alcohol-related conduct by an employee who does not hold a part 67 medical certificate.
Report Non-DOT/FAA Alcohol-Related Conduct - Part 67 Airmen Medical Certificate Holders (PDF) Use this sample reporting form to inform the Drug Abatement Division of non-DOT/FAA alcohol-related conduct by a part 67 medical certificate holder.
Report a Refusal to Submit to Testing - Part 61, 63, or 65 Certificate Holders (PDF) Use this sample reporting form to inform the Drug Abatement Division of a refusal to submit to testing by any individual that holds a part 61, 63 or 65 certificate. You must report all refusals by any individual that holds a part 61, 63 or 65 certificate to the FAA within 2 working days after the violation.
Report a Refusal to Submit to Testing - Employees other than Part 61, 63, or 65 Certificate Holders (PDF) Use this sample reporting form to inform the Drug Abatement Division of a refusal to submit to testing by an employee who does not hold a part 61, 63, or 65 certificate.
Program Audit Guide and Inspection Contact
Title Description
Inspection Guide (PDF) Use our Inspection Guide to help prepare for an inspection of your drug and alcohol testing program.
Employer Points of Contact (PDF) Before an inspection, submit this form to inform the Drug Abatement Division of necessary contact information, including your company representatives and service agents.
Emergency Maintenance Reporting
Title Description
Report Emergency Maintenance - 14 CFR Sections 135/91.147 Operators (MS Word) 14 CFR part 135 on-demand operators and 91.147 operators can use this sample form to report instances of emergency maintenance.
Report Emergency Maintenance - 14 CFR Part 91, for Fractional Ownership Operators (MS Word) 14 CFR part 91, subpart K fractional operators can use this sample form to report instances of emergency maintenance.

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This page was originally published at: https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/drug_alcohol/forms/