DEPARTMENT OF THE INTERIOR

IN-HOUSE SPECIMEN COLLECTION PROCEDURAL MANUAL

For 7 Part Federal Drug Testing Custody and Control Form (CC Form)

A. GENERAL

B. IMPORTANT POINTS

C. PRE-SPECIMEN COLLECTION

D. SPECIMEN

E. BOTTLE CUSTODY SEAL(s)

F. COMPLETING THE COC

G. COC FORM DISTRIBUTION

H. PREPARE SHIPPING BOX

I. SHIP SPECIMEN(s) TO LABORATORY

IN-HOUSE COLLECTION PROCEDURAL INSTRUCTIONS

NOTE: (Immediately contact the DOI Drug Program Program Staff, (202) 208-5638, if there are any questions or problems)

A. General

1. Effective January 1996, the Department is required to implement the Department of Transportation (DOT) alcohol and drug testing program. Consequently, we will have two drug testing programs operating: the Drug-Free Workplace Program, governed by the Department of Health and Human Services (HHS), and the DOT Program.

2. Single specimen drug test collections are performed under the HHS Program.

3. Split specimen drug test collections are required under the DOT Program which primarily covers employees who need commercial driver's licenses to perform their duties.

4. Items in BOLD require action on the part of the Collector or Donor.

B. Important Points

1. As soon as possible after the collection is performed, the Collector (or other appropriate on-site official) enters the Donor's test information into FAST - Federal Agency Specimen Tracking.

2. If there is no access to FAST, the Collector (or other appropriate on-site official) sends a Drug Test Request Form via facsimile machine to the next higher bureau organizational level for input into FAST. Be sure to include the Specimen Identification Number. This will ensure the results are tracked and reported back to the originator of the drug test request.

3. Collector is responsible for ensuring the collection site facilities are clean and well lighted.

4. Collector must keep specimen container in view of the Donor at all times prior to seal being placed on shipping box.

5. Please ensure split specimens are conducted only as required under DOT testing. Note: Split specimens are more costly.

6. Donor must provide photo identification:

(a) Agency identification badge with photo; or

(b) Driver's license with photo.

7. If no photo identification is provided, then the identification is to be made by an agency official who can positively identify the Donor.

C. Pre-Specimen Collection

1. Collector completes one Drug Testing Custody and Control Form, commonly known as Chain of Custody (CC Form), for each specimen. Use a ball point pen for all writing. Press down firmly to ensure all copies are legible. Detach the label half page (from right side of COPY 1 of the CC Form) and retain.

2. Collector identifies Donor by photo ID or by B7 above.

3. Collector completes STEP 1 Items A-E on COPY 1 of the CC Form:

(a) STEP 1A: Collector enters complete Bureau DOI number (see below):

Bureau DOI Numbers

OS - DOI6700
OSM - DOI6701

BLM - DOI6703
NPS - DOI6704
OIG - DOI6705
USGS - DOI6706
MMS - DOI6707
FWS - DOI6708
BIA - DOI6709
OAS - DOI6710

(b) STEP 1B: Collector writes "Dr. Oppenheim" who is our current Medical Review Officer.

(c) STEP 1C: Collector writes the Donor's SSN.

(d) STEP 1D: Collector checks the box which describes the reason for test (Pre-employment; Random; Reasonable Suspicion/Cause; Post Accident; Return to Duty; Follow-up; Other).

(e) STEP 1E: Collector puts an "X" in the tests to be performed box for "THC, Cocaine, PCP, Opiates and Amphetamines".

4. Collector asks Donor to remove unnecessary outer garments such as a coat or jacket. The Donor may retain wallet; however, all other personal belongings such as purse or briefcase need to remain with outer garments. NOTE: New HHS and DOT regulations require the Collector to direct the donor to empty his/her pockets and display items in them to ensure no items are present which could be used to adulterate the specimen.

5. Collector places bluing agent (tablets or liquid) in toilet water, wherever possible, in order to deter dilution of specimens.

6. Donor is instructed to wash and dry hands, where practical, after which no tap water can be run while specimen is actually collected.

7. Collector opens the specimen collection kit and removes the contents in the Donor's presence. This begins the requirement for the Collector to keep the specimen container in view of the Donor at all times.

8. If using public restroom, Collector remains in the restroom, but outside the stall, until the specimen is collected (in this case Collector must be the same gender as Donor).

9. Donor provides specimen in stall or otherwise partitioned area that allows for individual privacy. Donor gives specimen to Collector and then is allowed to flush toilet and wash hands.

D. Specimen

1. Volume. Collector determines volume of urine specimen bottle/container.

(a) FOR SINGLE SPECIMEN COLLECTIONS ONLY.

(1) Collector ensures 30 ml (approx. 1/2 bottle) of urine is provided in the specimen bottle.

(2) Collector transfers the urine specimen from the collection container (if one is used) to the specimen bottles in the Donor's presence.

(3) If an insufficient amount is collected (less than 30 ml), the collection container and urine must be discarded and another collection made using a new container. Collector then informs Donor a second specimen must be collected. Collector requests Donor consume a reasonable amount of liquid in order to provide specimen again; through a period of up to 3 hours.

(4) Donor must remain in collection area until specimen is provided. If Donor fails to provide 30 ml for second specimen, Collector must immediately contact the appropriate Bureau official for guidance on the action to be taken; or Collector must make a written record to that effect and provide to the Bureau official who is to be notified. If Bureau official is unavailable, Collector should contact the Bureau Drug Program Coordinator or Departmental Drug Program Coordination Staff.

(b) FOR SPLIT SPECIMEN COLLECTIONS ONLY.

(1) Collector ensures a total of 45 ml of urine is provided.

(2) Collector transfers the urine specimen from the collection container (if one is used) to the specimen bottles in the Donor's presence.

(3) Collector ensures primary specimen bottle contains at least 30 ml. Collector ensures split specimen bottle contains at least 15 ml.

(4) If less than 45 ml is provided, Collector follows the same procedures as D.1(a) above so that, in this instance, 45 ml is obtained.

2. Temperature

(a) Collector reads the specimen temperature:

(1) The time from urination to temperature measurement shall not exceed 4 minutes. If performed in the 4 minute time required, Collector checks "yes" in STEP 2 of CC Form.

(2) The temperature range must be from 90 degrees to 100 degrees fahrenheit.

(b) If the temperature is outside of the range,Collector must immediately contact the appropriate Bureau official for guidance on the action to be taken; or if unavailable, contact the Bureau Drug Program Coordinator or Departmental Drug Program Coordination Staff. A specimen temperature outside of the range may be a reason to believe the specimen was altered, and require another specimen to be collected under direct observation.

3. Visual Inspection. Collector inspects specimen's color and looks for any signs of contaminants. Collector shall note any unusual findings in remarks section of STEP 5 of the CC Form.

E. Bottle Custody Seal(s) (Attachment 4)

1. After specimen meets requirements above, Collector peels off the specimen bottle custody seal(s) containing the specimen number from COPY 1 of the CC Form and places over the top and down the sides for:

(a) Single Specimen: bottle A only;

(b) Split Specimen: both bottles A and B.

2. Collector records date of collection on security seal(s) for bottle(s).

3. Collector instructs Donor to initial security seal(s) for bottle(s).

4. If a bottle seal breaks and a substitution seal is required, the substitution needs to contain the specimen identification number from the CC Form so that the test can be processed. If no specimen identification number appears on the seal, the chain of custody for the specimen is broken; and the specimen cannot be tested. Note: Kit may contain extra security seal for bottle. Discard if not needed.

5. Collector places bar code label(s)/numbers on bottle(s), where available, bar code labels are located next to bottle seals. Extra unused bar code lables may be discarded.

F. Completing the CC Form

1. STEP 4

(a) Collector turns to COPY 4 of CC Form.

(b) Donor enters his/her daytime and evening phone numbers, and date of birth.

(c) Collector instructs Donor to read the certification statement, print his/her name, then sign and date the certification statement.

2. STEP 5

(a) Collector returns to COPY 1 of CC Form.

(b) Collector completes STEP 5, by entering:

(1) name and address of the facility at which the collection is taking place;

(2) a business telephone number;

(3) a check in the box indicating whether or not a split specimen was collected;

(4) any unusual occurrences concerning the collection in the remarks section.

(c) Collector completes the collection certification by printing and signing his/her name, and recording the date and time of collection (make sure to circle A.M. or P.M.).

3. STEP 6

NOTE: The Donor's name is not to appear anywhere on the CC Form in STEP 6.

The Collector:

(a) enters date of collection on the first line of the DATE column;

(b) does not write anything at all on the first line of the SPECIMEN RELEASED BY column (where "DONOR - NO SIGNATURE" is printed);

(c) prints and signs his/her name on the first line of the SPECIMEN RECEIVED BY column;

(d) enters date of collection on the second line of the DATE column;

(e) prints and signs his/her name on the second line of the SPECIMEN RELEASED BY column;

(f) prints "COURIER" on the second line of the SPECIMEN RECEIVED BY column;

(g) prints "SHIP TO LAB" on the second line of the PURPOSE OF CHANGE column (under "PROVIDE SPECIMEN FOR TESTING").

(h) The courier does not sign the CC Form since it will be sealed inside the shipping container along with the specimen(s) prior to pickup.

G. CC Form Distribution

1. COPY 1 (Original) goes to the laboratory with all specimens.

2. COPY 2 (Second Original) goes to the laboratory with all specimens.

3. COPY 3 goes to the laboratory with the split specimen only.

4. COPY 4 (Medical Review Officer copy) and COPY 7 (Employer copy) are sent by Collector via overnight Federal Express to:

Drug Program Staff
(202)208-5638
Department of the Interior
1849 C Street, NW, Mailstop 1366
Washington, DC 20240

Note: Another overnight courier service may be used if Federal Express is unavailable.

If the Medical Review Officer copy is not received in a timely manner, final test results will be delayed.

5. COPY 5 (Donor copy): Collector gives to Donor.

6. COPY 6 (Collector copy): Collector retains for his/her records.

H. Prepare Shipping Box

1. Collector ensures specimen bottle(s) contain proper amount of urine, specimen security bottle seal(s) are affixed, bar code label(s) are affixed to bottle(s), and CC Form is completed.

2. Collector places specimen bottle(s) in plastic transfer bag, and seals bag.

3. Collector places secured specimen bottle(s) into shipping box/container.

4. Once specimen is placed in box and box is sealed, the requirement to keep the specimen in view of Donor ends.

5. For single specimen, Collector puts COPY 1 and COPY 2 of CC Form and plastic transfer bag in the shipping box/container.

6. For split specimen, Collector puts COPY 1, COPY 2 and COPY 3 of CC Form and plastic transfer bag in the shipping box/container.

7. If the plastic bag has an outside pouch, copies of the CC Formshould be placed in the pouch before placing in the shipping box/container.

8. Collector seals the shipping box/container using the shipping box/container custody seal from COPY 1 of the CC Form (or other box seal provided). Collector initials and dates the shipping box/container custody seal.

I. Ship Specimen(s) to Laboratory

1. If the specimen is not immediately shipped, it shall be appropriately safeguarded during temporary storage (e.g., stored in a locked safe). Specimens are to be shipped within 24 hours of collection via overnight Federal Express to:

Workplace Drug Testing
(800)322-3361
Northwest Drug Testing
1141 East 3900 South
Salt Lake City, UT 84124

2. Collector completes Federal Express airbill form: contact DOI Drug Program Staff at (202)208-5638 for information and/or instructions).

3. Collector maintains appropriate receipt from Federal Express airbill (or other courier service used) and writes the specimen identification number on the airbill receipt. This allows tracking of the specimen in the event the package is lost.


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