Drug & Alcohol · Free Form
Random Testing Notification & Completion Record
Track a valid random selection from driver notification through collection confirmation and any unresolved follow-up.
Who It’s For
Designated employer representatives administering DOT random testing.
How to Use It
Use only after selection through the employer’s compliant random program or C/TPA. Keep selection confidential until notification, follow current collection instructions, and store the completed record with restricted program records. This form does not select drivers or replace collection forms.
What’s Included
- Selection and collection-site details
- Notification and arrival timeline
- Exception and DER follow-up
Keep testing unannounced. Once notified, the driver must proceed immediately; when doing a safety-sensitive task other than driving, cease it and proceed as soon as possible. Alcohol testing must occur during, just before, or just after safety-sensitive functions. Coordinate notice so the driver can act safely.
Do not give advance warning, substitute a different driver, excuse a selection, or label a refusal without applying the governing rules and program procedures. This sheet records logistics only; do not write test results or medical information here.
Put It into Practice
Need help applying this to your operation? Run the DOT Compliance Self-Check.
Related Downloads
Official References
Check the applicable requirements alongside your company procedures.
Using This Download
Is this a fillable PDF?
This is a printable 1-page PDF. Complete it by hand after printing, or add text with a PDF editor. It does not contain interactive form fields.
Can MSM customize it for our company?
Yes. MSM clients can ask their MSM team to adapt the resource to company procedures, reporting contacts, equipment, and branding. The standard public download is available to everyone.
Reviewed October 26, 2026. These resources support U.S. trucking safety work. Apply the rules, exceptions, equipment instructions, and state requirements relevant to your operation. A completed form does not by itself establish compliance.