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3 5 8 OCTAP DRUG & ALCOHOL TESTING <br /> SEMI-ANNUAL COMPLIANCE CHECKLIST & REVIEW <br /> <br />Semi-annual completion of this checklist and subn ~iital of the requested information are required of all OCTAP <br />permitted taxicab companies. Please complete the ~ollowing checklist (write in "N/A" if item is not applicable t <br />your company), attach the required information, then sign in the space provided at the bottom of the page. <br />Send this completed form and attached information to: OCTAP Administrator, P.O. Box 14184, Orange, CA <br />92863-1584. <br /> <br />(Name of Taxicab Company) <br /> <br />__ Attach a list of the names and social security numbers of all currently employed or contracted <br /> drivers. Include next to each name the testing location(s) and date(s) for all random controlled <br /> substance and/or alcohol tests administered to that driver in the last six months. <br /> <br />__ Fill in below the name, address and telephone number of the consortium and/or lab(s) that <br /> your company is currently using for drug and alcohol testing of drivers. If your company does <br /> not have an outside agency managing the program administration and selection of drivers for <br /> random drug and alcohol testing, also list below the name and telephone number of the <br /> person with your company in charge of random testing administration. <br /> <br />List below the name, test dates in tyre last six months, and testing locations for any drivers <br />who are currently subject to follow-up drug and/or alcohol tests after testing positive for drugs <br />and/or alcohol and then returning to duty. <br /> <br />List below the names of all supervisors who have completed the required two hours of <br />controlled substance and alcohol education training in the last six months. List next to each <br />supervisor's name the method of training, training location address, training location phone <br />number, and training supervisor's or instructor's name. <br /> <br />The signature below certifies that the above information is accurate and complete. It also acknowledges that <br />the taxicab company listed above is following all OCTAP, California and federal regulations pertaining to <br />taxicab driver drug and alcohol testing, <br /> <br />(Signature of Taxicab Company Owner or President) (Date) <br /> I:\pla nning\amyw\drugchek doc <br /> <br /> <br />