DOT FMCSA Consortium Random Pool Sign-up Form

  • Date Format: MM slash DD slash YYYY
  • Select the function of your company as an employer with one (1) or more employees or an Owner/Operator with no employees.
  • Enter the name of the individual who will be the direct contact for issues involving your drug & alcohol testing program.
  • Date Format: MM slash DD slash YYYY
    The DOT Operating Administration is the specific DOT regulatory agency in which your company complies.
    The Clearinghouse rule requires FMCSA-regulated employers, medical review officers (MROs), substance abuse professionals (SAPs), consortia/third party administrators (C/TPAs), and other service agents to report to the Clearinghouse information related to violations of the drug and alcohol regulations in 49 Code of Federal Regulations, Parts 40 and 382 by current and prospective employees.
    Owner/Operators Membership provides annual quarterly random selection services that meet DOT regulations, annual MIS report, DOT audit assistance, and report storage only, Clearinghouse Query Management, access to Client Portal. (One driver for the duration of your membership).
    Service includes Clearinghouse Management Services, 24/7 Access to our client portal for viewing reports, ordering testing services, and adding/removing drivers, Unlimited Drivers Added/Removed from driver list, discounted Policy Development or FREE Review of current policy, $10 Membership Discount on each pre-employment and random drug test ($89/ea), and $10 Membership Discount on each pre-employment and random breath alcohol test ($55/ea). Includes 1-FREE drug test per quarter (pre-employment or random).
    Service includes Clearinghouse Management Services, 24/7 Access to our client portal for viewing reports, Drug Test ordering assistance, unlimited drivers Unlimited Adding/Removal of drivers from random pool, FREE Review of current drug & alcohol testing policy, $10 Membership Discount on each pre-employment and random drug test (Regular price $89/ea), and $10 Membership Discount on each pre-employment and random breath alcohol test (Regular price $55/ea). Includes 1-FREE drug test per month (pre-employment or random).
  • Drop files here or
    You have the option to upload a detail list of your current active employees that will be added to the random pool. Information required on each employee includes: First and Last Name (as it appears on their driver's license), Date of Birth, Driver's License State and Number, Employee email address.
  • To view the current information on random testing rates visit the FMCSA page below.
    By checking the box, You agree to comply with regulations set forth by The Department of Transportation FMCSA regarding random pool entry, random drug & alcohol testing, and random selection procedures. You agree to provide the required information on your business and your drivers for membership enrollment purposes. By Checking the box, you also acknowledge that you have been notified, understand and accept that non-compliance with the DOT FMCSA random drug and alcohol testing guidelines and rules may lead to removal of yourself or your employees from the random selection pool. You acknowledge that you have read and understand the FMCSA rules for random selection and understand you or your employees may be selected up to 4 times per year based on the 50% annual testing rate and the quarterly testing frequency requirement. Your submission of this form is your agreement to comply with our random selection services offered.
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