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PRECISION COMPLIANCE INC. Presented By Precision Compliance, Inc. Bev Krieger C-SAPA Linda De Herrera PRECISION COMPLIANCE INC. Presented By Precision Compliance, Inc. Bev Krieger C-SAPA Linda De Herrera © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. – Today’s Presentation: • FTA Program Overview • Training and Education PRECISION COMPLIANCE INC. – Today’s Presentation: • FTA Program Overview • Training and Education Requirements – All safety-sensitive employees/education » Resource: http: //www. cutr. usf. edu/byrnessamsite – Supervisory staff/training » Resource: “A Training Program for Transit Supervisors” » http: //transitsafety. volpe. dot. gov/Publications/order/singledoc. asp? docid=362 • Service Vendors Oversight – Collection Sites » Resource: Specimen collection procedures » http: //transitsafety. volpe. dot. gov/Publications/order/singledoc. asp? docid=783 © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. – Substance Abuse Professional » Resource: SAP Guidelines » http: //transitsafety. PRECISION COMPLIANCE INC. – Substance Abuse Professional » Resource: SAP Guidelines » http: //transitsafety. fta. dot. gov/publications/order/singledoc. asp? do cid=982 – Medical Review Officer – Third Party Administrator (C/TPA) – Over the Counter and Prescription Medication – Contractor Oversight – Q and A © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Prohibited Substances – Marijuana – Cocaine – Amphetamines – Opiates PRECISION COMPLIANCE INC. • Prohibited Substances – Marijuana – Cocaine – Amphetamines – Opiates – Phencyclidine – Alcohol © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. © Precision Compliance, Inc. PRECISION COMPLIANCE INC. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Safety-Sensitive Employees – Operates a revenue service vehicle – Operates PRECISION COMPLIANCE INC. • Safety-Sensitive Employees – Operates a revenue service vehicle – Operates a non-revenue service vehicle that requires CDL – Controls movement or dispatches revenue service vehicle – Maintenance of revenue service vehicle, – Includes all engaged in engine, revenue service vehicle and parts repair, rebuilding and overhaul. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Safety-Sensitive Employees, continued – Security personnel that carry firearms – PRECISION COMPLIANCE INC. • Safety-Sensitive Employees, continued – Security personnel that carry firearms – Contracted services “standing in your shoes” – Supervisors are exempt unless they perform safetysensitive function – Volunteers if they are required to hold a CDL or if they receive remuneration in excess of actual expenses incurred. – Exemption: Contracted maintenance by systems that serve populations <200, 000 © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Testing Timeframe – Drugs - while on Duty – Alcohol PRECISION COMPLIANCE INC. • Testing Timeframe – Drugs - while on Duty – Alcohol - Just before, during or just after performing a safety-sensitive function • Alcohol is prohibited – – While on duty performing safety-sensitive duties 4 hours prior to duty 8 hours following an accident or until tested While on call. • Consumption of drugs is prohibited at all times © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • TESTING CATEGORIES – Pre-employment (drug required/alcohol optional) – Random – PRECISION COMPLIANCE INC. • TESTING CATEGORIES – Pre-employment (drug required/alcohol optional) – Random – Post-Accident – Reasonable Suspicion – Return-to-duty (observed collection) – Follow-up (observed collection) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Pre-Employment Requirements – All new employees prior to performing safetysensitive PRECISION COMPLIANCE INC. • Pre-Employment Requirements – All new employees prior to performing safetysensitive duties. • Be able to show when employee began safety sensitive duties. – Prior to transfer into safety-sensitive positions – New applicant acknowledgment form – Negative test result prior to starting safety sensitive function. Is it documented? – Not more than 90 days prior to employment – No waivers or previous employer’s statements as in FMCSA © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Pre-Employment (continued) – No FTA pre-employment test in this situation. PRECISION COMPLIANCE INC. • Pre-Employment (continued) – No FTA pre-employment test in this situation. Following – – – temporary leave - (less than 90 days: vacation, sick leave, jury duty) Temporary leave of 90 days or more and out of the pool pre-employment test required Disabled individuals unable to provide sufficient volume, may have a medical exam, then can be reported as negative (ADA) Refer any applicant with a positive result to a SAP Ask all applicants if they have previously tested positive in a pre-employment situation (documentation). Check previous employers for the past 2 years regarding any positive drug, alcohol or refusals that may have occurred with a new applicant. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Random Testing – Only USDOT safety-sensitive employees (must test to PRECISION COMPLIANCE INC. • Random Testing – Only USDOT safety-sensitive employees (must test to the highest rate if pool includes other than FTA employees) – Limited access to selections – FTA minimum rates for Alcohol 10% – FTA minimum rates for Drugs 25% – Updating pool for accuracy – Scientifically valid methods – Spread throughout all hours of operation and days of the week – Testing should be able to start at the beginning of the testing period (quarterly, monthly, etc. ) – alternate draws © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Hrs. of Operation: 6: 00 am-6: 30 pm © Precision Compliance, PRECISION COMPLIANCE INC. Hrs. of Operation: 6: 00 am-6: 30 pm © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Monday-Friday Service © Precision Compliance, Inc. PRECISION COMPLIANCE INC. Monday-Friday Service © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Random, Follow-up and Reasonable Suspicion testing must be done immediately PRECISION COMPLIANCE INC. • Random, Follow-up and Reasonable Suspicion testing must be done immediately after employee notification – Drugs, anytime on duty – Alcohol, just before, during, or just after performing a safety-sensitive function – Collection cannot be predictable – No advance notification – Avoid group testing © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Post Accident FTA Thresholds – Requirements for testing • A PRECISION COMPLIANCE INC. • Post Accident FTA Thresholds – Requirements for testing • A fatality • An individual suffers bodily injury and immediately receives medical treatment away from the scene of the accident • If any vehicle involved in the accident sustains disabling damage © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Post Accident (continued – Who is tested • each safety-sensitive PRECISION COMPLIANCE INC. • Post Accident (continued – Who is tested • each safety-sensitive employee operating the vehicle at the time of the accident • any other safety-sensitive employee whose performance could have contributed to the accident • supervisor’s determination of who is to be tested based on best information they receive • employee must be told to remain readily available for testing © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Post Accident (continued) – Testing can be done if accident PRECISION COMPLIANCE INC. • Post Accident (continued) – Testing can be done if accident does not meet FTA thresholds but under your own authority. Must use Non Federal Custody and Control Forms – In the rare event the employee cannot participate in FTA collection procedures, employer can accept results from Federal, State, or local officials if results are released © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Post Accident (continued) – Alcohol • • test should be PRECISION COMPLIANCE INC. • Post Accident (continued) – Alcohol • • test should be done as soon as possible but not longer than 8 hours following accident If not done within 2 hours, document, why? Cease all attempts if not done within 8 hours, document, why? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Post Accident (continued) – Drugs • testing should be done PRECISION COMPLIANCE INC. • Post Accident (continued) – Drugs • testing should be done as soon as possible, but not more than 32 hours • if not done within 32 hours, document, why? – Document all accident information and decision making processes. – Develop a Post-Accident Kit for all supervisors who may respond to an accident/incident. • • • Post accident documentation form CCF (both Federal and non Federal if testing is being done under the system’s authority) Instructions Contact numbers Any other forms (insurance, Municipal, etc. ) – Train (and refresh) supervisors on accident response © Precision Compliance, Inc.

© Precision Compliance, Inc. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Post Accident (common problems) – Accident does not meet the PRECISION COMPLIANCE INC. • Post Accident (common problems) – Accident does not meet the FTA Thresholds – Employee can be discounted as a contributing factor yet, testing is done – Lack of Documentation – Testing often not done or significantly delayed – Lack of training for safety-sensitive employees and supervisors – Lack of supervisor empowerment © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Reasonable Suspicion – Employer has reasonable suspicion that employee has PRECISION COMPLIANCE INC. • Reasonable Suspicion – Employer has reasonable suspicion that employee has used prohibited drug, has misused alcohol or presents behavior that reflects on his/her ability to perform duties safely. – Request must be based on specific, contemporaneous articulate observations concerning appearance, speech, or body odor – Provides management with a tool to identify impaired employees © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Reasonable Suspicion (continued) – Supervisors must be trained in: • PRECISION COMPLIANCE INC. • Reasonable Suspicion (continued) – Supervisors must be trained in: • the facts, circumstances, physical evidence, physical signs and symptoms, patterns of performance and/or behavior • must know proper procedure • must document • employee should be transported to collection site and home © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Reasonable Suspicion (continued) – Timeframe for Drug testing is anytime PRECISION COMPLIANCE INC. • Reasonable Suspicion (continued) – Timeframe for Drug testing is anytime a person is on duty • Timeframe for Alcohol testing is during, just preceding or immediately following the performance of a safety-sensitive function • Testing must be done as soon as possible if delayed reason must be documented © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Return to Duty (Second Chance Policy) – Any positive drug PRECISION COMPLIANCE INC. • Return to Duty (Second Chance Policy) – Any positive drug test, 0. 04 or greater alcohol test, refusal to submit, or any other violation of regulation – Must be referred to Substance Abuse Professional (SAP) – Only SAP can release an employee to return to work – Must have a negative return to work drug test and an alcohol test less than 0. 02 based on the SAP recommendation. – Return to duty test is always collected under the observed protocol © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Return to Duty (continued) – Purpose • provide some degree PRECISION COMPLIANCE INC. • Return to Duty (continued) – Purpose • provide some degree of assurance to the employer that the individual is presently free of alcohol and/or any prohibited drugs • Employee is able to return to work without undo concern about continued substance abuse – The SAP can do both alcohol and drug return to work testing even though the original infraction was only drugrelated © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Follow-Up Testing (Second Chance Policy) – Once a SAP releases PRECISION COMPLIANCE INC. • Follow-Up Testing (Second Chance Policy) – Once a SAP releases an employee to return to work (in writing) – Minimum testing is 6 tests in 12 months – Employee shall be subject to unannounced follow-up testing for at least 12 months but not longer than 60 months – Non-negotiable – SAP sets frequency and duration – Follow-up testing must be collected under the observed protocol © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Education/Training Requirements – Education Materials – Training all safety-sensitive employees PRECISION COMPLIANCE INC. • Education/Training Requirements – Education Materials – Training all safety-sensitive employees prior to performing a safety sensitive function, including policy review, 60 minutes drug education plus understand of the alcohol rules. – Training for supervisors must include 60 minutes of training on the signs and symptoms of alcohol misuse and 60 minutes on drug abuse. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Collection Site – Develop a procedure for notifying site regarding PRECISION COMPLIANCE INC. • Collection Site – Develop a procedure for notifying site regarding employee’s arrival time and information regarding notifying the DER – Develop a consistent process to receive the employer copy of the custody and control form. – Have access to the Specimen Collection Guidelines and the new Part 40 regulations and offer them to your site. – Perform annual audits of your collection site. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. – Review prior to collection • • All water sources turned PRECISION COMPLIANCE INC. – Review prior to collection • • All water sources turned off and bluing in the receptacle Secure toilet tank top or use bluing Ensure undetected access is not possible No chemicals (soap, bleach etc) in the toilet area Secure areas suitable for concealing contaminants Donor instruction in specimen area Secured area for specimens and collection procedures – Certified collection employees • Check qualifications, training and proficiency – Use of correct Chain of Custody Form © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Collection Site (continued) – Only one collection at a time PRECISION COMPLIANCE INC. • Collection Site (continued) – Only one collection at a time unless shy bladder wait period – Sample must be in view of collector and employee until completion of the process – Collector must maintain personal control over each specimen – Collector must have contact information on the DER – Perform the alcohol test before the drug test © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Drug Testing Procedure (continued) – Collector – Mandatory Observed Collections PRECISION COMPLIANCE INC. • Drug Testing Procedure (continued) – Collector – Mandatory Observed Collections • • All return to duty and follow-up tests Directed by the DER or MRO Observed materials brought to the collection site Employee’s conduct clearly indicates a clear attempt to tamper or adulterate • Temperature on the original specimen was out of range • Original specimen appears to have been tampered with © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Observed Collections continued – Employee must be informed of the PRECISION COMPLIANCE INC. • Observed Collections continued – Employee must be informed of the reason for the observed collection – Observation must be done by a person of the same gender – New protocol requires that the donor drops his/her pants/skirts to mid thigh and pull up their shirts up and turn around to ensure they are not using a prosthetic device. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. How to audit your Collector (Best practice: annual collection audit site PRECISION COMPLIANCE INC. How to audit your Collector (Best practice: annual collection audit site visit) q Has the site received documented training? q Does the site have a copy of the new regulations and is the collector familiar with them? q Are the supplies readily available? q Are CCFs available for both DOT and non-DOT testing if appropriate? q Does the collector inspect the voiding area prior to the collection? q Is there a procedure for contacting the DER? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q Does the collector understand the observed specimen collection protocols? q PRECISION COMPLIANCE INC. q Does the collector understand the observed specimen collection protocols? q Does the collector understand what to do if there is insufficient volume? q. Are the specimens kept in a secure location while waiting for the courier? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Laboratory Procedures – Urinalysis for drugs • Split specimen • PRECISION COMPLIANCE INC. • Laboratory Procedures – Urinalysis for drugs • Split specimen • Federal Chain-of-Custody and Control Form – (5 part) • Validity testing • Initial Screen • Confirmation test © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Must be HHS certified • Validity testing determines if the PRECISION COMPLIANCE INC. • Must be HHS certified • Validity testing determines if the specimen is consistent with normal human urine • Creatinine level • Specific gravity • p. H – Adulterants • • a substance not expected in human urine a substance expected but is present at inappropriate levels physical characteristics that are outside normal range if unable to ID the adulterant, must be sent to different lab © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Invalid • Unidentified adulterant or unidentified interfering substance • Abnormal PRECISION COMPLIANCE INC. • Invalid • Unidentified adulterant or unidentified interfering substance • Abnormal physical characteristics • Normally found substance but found at an abnormal concentration • Substance which prevents lab from completing or obtaining a valid test result © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Primary specimen – – – Initial screening (immunoassay) Confirmation if PRECISION COMPLIANCE INC. • Primary specimen – – – Initial screening (immunoassay) Confirmation if positive by GC/MS Approved by certifying scientist Results transmitted to MRO same day Storage of positive results for 1 year (minimum) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Split specimen • Long term frozen storage for one year PRECISION COMPLIANCE INC. • Split specimen • Long term frozen storage for one year if primary test is positive • Split specimen is forwarded to other HHS laboratory when requested • Validity testing required • Testing for the presence only (not for cut off levels) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Turnaround time to the MRO should be no longer than PRECISION COMPLIANCE INC. • Turnaround time to the MRO should be no longer than 48 hours for negative results and 72 for positive results • Maintain records for 2 years unless request to maintain longer • Must provide semi-annual statistical summaries to the employer*-unless there is less than 5 tests in a period. Often the Third Party Administrator/Consortium will receive the statistical summary. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Alcohol Testing Procedure – Breath testing • Evidential Breath Testing PRECISION COMPLIANCE INC. • Alcohol Testing Procedure – Breath testing • Evidential Breath Testing device (EBT) • 0. 02 -0. 039 removed from safety-sensitive for 8 hours or subsequent test reads below 0. 02 • 0. 04 or greater is a positive alcohol test • must be referred to Substance Abuse Professional (SAP) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Saliva Screening Test – If reading is non-negative must be PRECISION COMPLIANCE INC. • Saliva Screening Test – If reading is non-negative must be confirmed with EBT 15 minutes minimum and not longer than 30 minutes – Direct Supervisors can not act as STTs or BATs • BAT/STT training requirements – Basic information • Knowledgeable of 49 CFR part 40 and current DOT guidance. – Qualification training • Proficiency on the device • Responsibility for maintaining – Integrity of the testing process and equipment – Privacy and dignity of employees © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • BAT/STT Requirements – Initial proficiency demonstration • Seven error free PRECISION COMPLIANCE INC. • BAT/STT Requirements – Initial proficiency demonstration • Seven error free tests • Performance monitored • Monitor documents that the tests were error free – Refresher training • Every five years – Error correction training • Required if a mistake results in a cancelled test • Completed within 30 days of when notified • Training and proficiency demonstrated and documented by monitor • Conduct 3 consecutive error free mock collections © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. How to audit your BAT/STT (face to face site visit audit) PRECISION COMPLIANCE INC. How to audit your BAT/STT (face to face site visit audit) q Does the BAT/STT have a certificate? q Have they shown proficiency on the device they are using? q Is the alcohol test performed prior to a urine drug test? q Is there a BAT available all hours of your operation? q Does the BAT know how to contact the DER? q Are all confirmations performed by the BAT using an approved EBT? q Is the donor’s ID checked? Back up procedure? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q Is only one test done at a time? q Does PRECISION COMPLIANCE INC. q Is only one test done at a time? q Does the BAT understand that a refusal by the donor to sign step 2 is a refusal to test? q Does the BAT wait at least 15 minutes to do a confirmation (if necessary) q Does the BAT understand procedures for insufficient volume of breath? q Are there records of adherence to the QAP? q Is the EBT stored in a secured location? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Consequences of Positive tests – Positive test communicated by your PRECISION COMPLIANCE INC. • Consequences of Positive tests – Positive test communicated by your MRO • Removed from Safety-Sensitive position • Referred to SAP • Disciplinary policy – Refusal to test treated the same as a positive – Definition of a refusal? • Verbal or Physical refusal • Insufficient volume without medical explanation © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Refusal to Test – Tampering or adulterating specimen – Not PRECISION COMPLIANCE INC. • Refusal to Test – Tampering or adulterating specimen – Not reporting immediately for testing – Leaving the scene of an accident prior to submitting a test, without just cause – Not signing the Alcohol Testing Form step 2. – Not allowing an observed or monitored collection when required – Not allowing a medical examination when required. – Leaving the collection site prior to completing the process (except in the case of pre-employment) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Medical Review Officer (MRO) – Licensed physician with detail knowledge PRECISION COMPLIANCE INC. • Medical Review Officer (MRO) – Licensed physician with detail knowledge of substance abuse disorders and drug testing and 49 CFR part 40, MRO guidelines and agency regulations • Knowledgeable about adulterated and substituted specimens • Purpose to review, interpret and verify test results, of positive, adulterated or dilute test • Notify employee of confirmed positive test • Review employees medical history/medical records • Protects the employee • No conflict of interest © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • MRO Responsibilities – Verify lab results – Inform employee of PRECISION COMPLIANCE INC. • MRO Responsibilities – Verify lab results – Inform employee of rights to request split specimen test within 72 hours – Notify employer of positive test results – Notify employer of safety concerns, if appropriate – Process split test for employee – Split test results are reported to employer by the Mro – Notify employer of retest request – Maintain all necessary records – MRO can not use alternative specimens (i. e. hair, blood etc © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Employee notification – non negative – Notify employee of confirmed PRECISION COMPLIANCE INC. • Employee notification – non negative – Notify employee of confirmed positive, adulterated, etc. • 3 attempts in 24 hours • If unable to contact, notify the DER – Results not discussed – The DER should instruct employee to contact MRO – If no contact within 24 hours, DER to leave message and notify the MRO – Verify positive test results without interview » Employee refuses to discuss results with MRO » After contacted by DER, Employee does not get in contact with MRO. Result in 72 hours » No contact with donor in ten days after a good faith effort © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Verified test results – – Negative: no action Negative dilute: PRECISION COMPLIANCE INC. • Verified test results – – Negative: no action Negative dilute: employer may retest (be consistent) Positive: rule violation Positive dilute: rule violation © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. How to Audit your MRO (not necessarily a face to face PRECISION COMPLIANCE INC. How to Audit your MRO (not necessarily a face to face audit) q Does the MRO have the appropriate current credentials? q Does the MRO have a copy of the MRO Guidelines? q Are all negative results reviewed by the MRO or his/her designated staff q If designated staff does the MRO review are 5% of the tests reviewed personally by the MRO to verify accuracy? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q Does the MRO use a script to ensure all information PRECISION COMPLIANCE INC. q Does the MRO use a script to ensure all information and disclosure is given to the donor during the interview? q Does the MRO interview each donor with a nonnegative or questionable result? q Does the MRO make at least 3 attempts in 24 hours to contact a donor? q Does the MRO then notify the DER? q Does the MRO understand the time frames for a non-contact positive result? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q Does the MRO inform the donor he/she has 72 hours PRECISION COMPLIANCE INC. q Does the MRO inform the donor he/she has 72 hours to request the split sample test? q Does the MRO notify the DER if a test must be retaken and under what circumstances? q Does the MRO understand the new procedures for dealing with adulterated, diluted and unsuitable specimens? q Does the MRO report results in a confidential manner © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Substance Abuse Professional (SAP) – Licensed physician – Licensed or PRECISION COMPLIANCE INC. • Substance Abuse Professional (SAP) – Licensed physician – Licensed or certified • • Psychologist Social Worker Employee Assistance Professional Addiction counselor certified – National Association of Alcoholism and Drug Abuse Counselors Certification Commission – International Certification Reciprocity Consortium © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • www. dot. gov/ost/dapc • Knowledge of and clinical experience in PRECISION COMPLIANCE INC. • www. dot. gov/ost/dapc • Knowledge of and clinical experience in diagnosis and treatment of drug and alcohol related disorders • No conflicts of interest or financial interest in referrals • To protect the public and employer • Not a cookie cutter program, must be individualized • 49 CFR part 40 subpart O © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • SAP Responsibilities – Evaluate type and amount of assistance needed PRECISION COMPLIANCE INC. • SAP Responsibilities – Evaluate type and amount of assistance needed by employee – Determine if employee successfully completed recommended treatment • Confer with treatment professionals • Conduct face to face interview – Provide a written report to the DER – Specific guidelines for reports are in 40. 311 – Determines when employee is ready to return-towork and follow-up testing duration and frequency – Referrals are required for all positive tests © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. SAP Audit (not necessarily a face to face audit) q Does PRECISION COMPLIANCE INC. SAP Audit (not necessarily a face to face audit) q Does your SAP have the appropriate credentials? Request copy of their SAP Certificate q Is the SAP familiar with the part 40 guidelines? q Does the SAP have a copy of the regulations? q Are all individuals who have a positive result or refuse to test referred to a SAP? q Are all applicants that test positive or refuse a pre-employment test given the name of a SAP? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q Does the SAP conduct a face to face evaluation with PRECISION COMPLIANCE INC. q Does the SAP conduct a face to face evaluation with the donor? q Does the SAP always recommend some assistance, either treatment or education? q Does the SAP evaluate if an employee successfully complied with the recommended assistance? q Does the SAP provide a written report to the you? q Does the SAP establish the appropriate time for a return to duty test? q Does the SAP recommend the duration and frequency of the follow-up tests? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q Does the SAP have a conflict of interest with the PRECISION COMPLIANCE INC. q Does the SAP have a conflict of interest with the treatment or education provider? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • C/TPA – Transit systems are responsible for the integrity of PRECISION COMPLIANCE INC. • C/TPA – Transit systems are responsible for the integrity of the drug and alcohol program – A Consortium/Third Party Administrator may perform some tasks on behalf of the employer • May act as an intermediary in the transmission of testing information – Must ensure that transmissions meet the requirements that would apply to the service agent • May operate random testing programs • May assist with laboratory and collection sites • May not randomly select for follow-up testing © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • May receive and receive all drug and alcohol test results PRECISION COMPLIANCE INC. • May receive and receive all drug and alcohol test results (except positive alcohol test results) • C/TPA must ensure that if acting as an intermediary in transmitting information it must be in the appropriate timeframes • Must ensure that employer’s records are available within 2 days or request • On request of employer, must transfer immediately all records pertaining to the employer and its employees. • Must notify employers if C/TPA is going out of business, merging or selling the organization © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • C/TPA may offer MRO services • MRO services must be PRECISION COMPLIANCE INC. • C/TPA may offer MRO services • MRO services must be independent of C/TPA services. • May not act as an intermediary in the transmission of alcohol test result of 0. 02 or higher • May not act as an intermediary of SAP reports © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Auditing your C/TPA q Does the C/TPA have the latest regulations PRECISION COMPLIANCE INC. Auditing your C/TPA q Does the C/TPA have the latest regulations and guidelines? q Does the C/TPA share this information with the Service agents? q Does the C/TPA keep you updated with any changes? q Does the C/TPA have a system of maintaining quality of the service agents they recommend? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q. Do they help you respond to cancelled tests due to PRECISION COMPLIANCE INC. q. Do they help you respond to cancelled tests due to collection errors? q. Does the C/TPA belong to any professional organizations? Do they go to meetings? q. Are they supplying the correct CCFs? q. Will they supply you with non-federal CCFs? © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. . © Precision Compliance, Inc. PRECISION COMPLIANCE INC. . © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. The FTA published The Prescription and Over-the. Counter Medications Tool Kit PRECISION COMPLIANCE INC. The FTA published The Prescription and Over-the. Counter Medications Tool Kit – Contains current transit agency policies to serve as examples for employers in creating a new policy or revising an existing policy on Rx and OTC medications. – These examples demonstrate three different policy approaches: • (1) responsibility is placed on the employees to determine their own ability to safely perform their duties while using medications; © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • (2) proactive involvement by the employer requiring authorization by medical PRECISION COMPLIANCE INC. • (2) proactive involvement by the employer requiring authorization by medical practitioners that may include a final determination review by the employer’s medical review officers (MROs) or other physicians; • 3) use of a list of medications to guide employees and medical practitioners on which medication may or may not be used, and those medications that must be approved for use. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • FTA recommended policy content – Acknowledges risks associated with Rx/OTC PRECISION COMPLIANCE INC. • FTA recommended policy content – Acknowledges risks associated with Rx/OTC use – Emphasizes safety – Balances treatment of medical conditions and the requirements of performing Safety Sensitive job duties – Not intended to force employees in need of medical attention to work or keep employees eligible to work off duty for receiving treatment © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Policy Content, cont. – Define process and procedures that reflect PRECISION COMPLIANCE INC. • Policy Content, cont. – Define process and procedures that reflect your agency’s policy • Procedure for obtaining medical input into employee’s fitness for duty • Procedure for removing employees form safety-sensitive duty who are impaired by Rx/OTC medications • An attendance policy that reflects Rx/OTC related absence and limitations on use of sick leave • Use of benefits (leave, vacation time etc. ) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Policy Content, cont. – Define Consequences of Violating Policy • PRECISION COMPLIANCE INC. • Policy Content, cont. – Define Consequences of Violating Policy • Use of Rx/OTC meds that contribute to cause or increase the severity of an accident • Failure to report use • Failure to obtain medical authorization • Other policy provision violations © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Policy Content, cont. – Ensure that the policy emphasizes confidentiality PRECISION COMPLIANCE INC. • Policy Content, cont. – Ensure that the policy emphasizes confidentiality • Records • Medical interaction – Define Roles and Responsibilities • • • Employee Manager/Supervisors Medical Practitioner Pharmacist MRO © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Management Responsibilities – Establish policy and procedures • Determine content PRECISION COMPLIANCE INC. • Management Responsibilities – Establish policy and procedures • Determine content and process for medical review • Define notification process – Institute employee Rx/OTC awareness and training – Establish consequences for a policy violation – Create record keeping, information disclosure and confidentiality procedures © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Generic brochure: Over the Counter Medications, What's right for you? PRECISION COMPLIANCE INC. • Generic brochure: Over the Counter Medications, What's right for you? The New Over the Counter Medicine Label, Take a Look • For free bulk quantities, write: Consumer Healthcare Products Association Publications Department 1150 Connecticut Ave. , N. W. Washington, D. C. 20036 Or visit www. chpa-info. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Employee’s Records • Drug Test result • Employer copy of Custody PRECISION COMPLIANCE INC. Employee’s Records • Drug Test result • Employer copy of Custody and Control Form • Copy of Employee Policy and Procedure signature of receipt form • Employee pre-employment acknowledgment • Previous employers’ D&A records • Post accident/Reasonable Cause report • SAP information • Training records © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • Five Year Requirement – Positive Drug test results – Alcohol PRECISION COMPLIANCE INC. • Five Year Requirement – Positive Drug test results – Alcohol test results greater than 0. 02 – Chain of Custody Form – Documentation of test results – Employee dispute – Employee referral to SAP – Return-To-Work/Follow-up testing – MIS Reports © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Two Year Requirement – Random Selection process – Reasonable Suspicion Documentation PRECISION COMPLIANCE INC. Two Year Requirement – Random Selection process – Reasonable Suspicion Documentation – Post Accident Testing documentation – MRO documents verifying existence of medical explanation for insufficient volume – Education and training for safety-sensitive employees and supervisor. © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. • One Year Requirement – Negative test results – Alcohol results PRECISION COMPLIANCE INC. • One Year Requirement – Negative test results – Alcohol results of less than 0. 02 – Alcohol test forms with results – Employer’s copy of the USDOT Custody and Control Form © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Self Audit q. Review your procedures for all testing events q. PRECISION COMPLIANCE INC. Self Audit q. Review your procedures for all testing events q. Review your paper-trails and accompanying documentation q. Graph the times and days of your random tests q. Be sure your MRO is sending signed (or stamped for negatives) complete results for each test which include: q. Employee’s full name as indicated on the CCF q. Specimen ID number for the CCF q. Reason for the test as indicated on the CCF © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q. Date of the collection q. Result of the test q. PRECISION COMPLIANCE INC. q. Date of the collection q. Result of the test q. The date the result was verified by the MRO q. For verified positive tests, the drug metabolite(s) for which the test was positive q. For cancelled tests, reason for the cancellation q. For refusals to test, the reason for the refusal (name of the adulterant) © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. q. Be sure to review your CCF to ensure that: q. PRECISION COMPLIANCE INC. q. Be sure to review your CCF to ensure that: q. The employer’s name (your name) is in the appropriate space on the upper left hand corner of the CCF q. Also the employer’s address, phone and fax number is required in the same area. q. The MRO’s name, address, fax and phone number must appear in the appropriate section q. The C/TPA may have their name on the CCF q. Specify the DOT Authority (FTA) q No shadow initials © Precision Compliance, Inc.

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PRECISION COMPLIANCE INC. Questions and Answers Thank You Bev © Precision Compliance, Inc. PRECISION COMPLIANCE INC. Questions and Answers Thank You Bev © Precision Compliance, Inc.

PRECISION COMPLIANCE INC. Good Job! Give yourself a slap on the back © Precision PRECISION COMPLIANCE INC. Good Job! Give yourself a slap on the back © Precision Compliance, Inc.