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FTA Testing Decision Making Form
FTA Post-Accident Drug and Alcohol Testing Decision Making Form
The Federal Transit Administration (FTA) drug and alcohol testing regulation (49 CFR Part 655) requires that safety-sensitive employees involved in a public transportation vehicle accident (as defined at 655.4 & 655.44) submit to tests for alcohol misuse and prohibited drug use as soon as possible following the accident. Part 655 also requires the testing of any other safety-sensitive employee whose performance could have contributed to the accident, as determined by the employer at the scene using the best information available at the time of the decision.
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Accident Information
Accident Date & Time
*
Date
Time
Employee Name
*
Employee Full Name
Employee ID
*
Numeric Value
Decision Questions
Was there a fatality?
*
Yes (FTA drug and alcohol tests are REQUIRED)
No
If Answered No fatality
1. Has any individual suffered a bodily injury and immediately received medical treatment away from the scene of the accident?
Yes
No
2. Was there any disabling damage to any vehicle involved in the accident, requiring the vehicle to be towed away from the scene?
Yes
No
3. Was the vehicle (if rail car, trolley car, trolley bus, or vessel) removed from operation?
Yes
No
If you answered yes to any of these three questions, can you completely discount the performance of the operator of the public transportation vehicle as a contributing factor to the accident?
No (FTA drug and alcohol tests are REQUIRED)
Yes
If "yes", Explain
If you answered YES, FTA drug and alcohol tests are PROHIBITED
Other than the operator, could the performance of any other safety-sensitive employee have contributed to the accident, using the best information available
No
Yes
If "yes", Explain
If you answered YES, make arrangements to immediately post-accident test that employee
Did You Decide to Perform a Drug or Alcohol Test?
Yes (Complete page 2 of this form)
No ((No further action required)
Time of Decision to Conduct a DOT/FTA Post-Accident Test:
Time (AM/PM)
Testing Information
Collection Site Location
Time Arrived
AM/FM
1. Was the alcohol test performed within 2 hours of the time of the accident?
Yes
No
If "No", Explain
2. Was the alcohol test performed within 8 hours of the time of the accident?
Yes
No
If "No", Explain
3. Was the drug test performed within 32 hours of the time of the accident?
Yes
No
If "No", Explain
Submit
