URINE INITIAL DRUG SCREEN RESULT FORM - CLIA waived 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Completed by Collector or Employer Representative' section. Enter the collection site or company name, address, city, state, phone, and fax number.
3. Provide the donor's identification details including SSN, driver's license, or employee ID number. Ensure that the ID is verified by checking the appropriate box.
4. Fill in the donor's name and reason for testing. Select from options such as Pre Employment, Random, Reasonable Suspicion/Cause, Post Accident, or Return to Duty.
5. Record the specimen temperature within four minutes and indicate whether it falls within the normal range of 90º - 100ºF (32º - 38ºC).
6. Complete the 'Initial Test Results' section by documenting results from on-site screening devices and specimen validity tests. Mark each drug tested as NEG (negative), PRESUMPTIVE POSITIVE, or NOT TESTED.
7. Finally, ensure that both collector and donor sign where indicated to certify completion of the form.

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