CHECKLIST AUDIT COLLECTION SITE-3

CONNECTICUT DRUG AND ALCOHOL TESTING CONSORTIUM COLLECTION SITE AUDIT CHECKLIST ───────────────────────────────────────── I. INITIAL BREATH ALCOHOL TEST □ ALWAYS CONDUCT BREATH ALCOHOL TEST FIRST □ PHOTO ID REQUESTED □ NO REQUEST FOR CONSENT, WAIVER, INDEMNIFICATION OR RELEASE FORM REQUESTED BE SIGNED □ BAT EXPLAINS PROCEDURE & REVIEWS INSTRUCTIONS ON BACK OF ALCOHOL TESTING FORM □ DOT ALCOHOL TESTING FORM (ATF) USED □ BAT COMPLETES SECTION 1 OF ATF □ BAT REQUESTS DONOR COMPLETE SECTION 2 AND SIGN CERTIFICATION □ BAT OPENS A SEALED MOUTHPIECE IN VIEW OF EMPLOYEE □ BAT INSTRUCTS EMPLOYEE TO BLOW INTO THE MOUTH- PIECE FOR AT LEAST SIX SECONDS (or until machine indicated that an adequate amount had been obtained) □ BAT SHOWS EMPLOYEE RESULT DISPLAYED ON EBT □ EBT MACHINE PRINTS TEST NUMBER, TESTING DEVICE NAME AND SERIAL NUMBER, TIME AND RESULT -OR- □ BAT COMPLETES SECTION 3 OF THE ATF BY RECORDING TEST NUMBER, TESTING DEVICE NAME AND SERIAL NUMBER, TIME AND RESULT □ EBT PRINTED REPORT AFFI XED TO ATF WITH TAMPER- EVIDENT TAPE □ RESULT < .02, SECTION 3 OF ATF COMPLETED □ COPY 1 TO EMPLOYER, COPY 2 TO EMPLOYEE, RETAIN COPY 3 □ ALL NECESSARY EQUIPMENT, PERSONNEL AND MATERIALS WERE AVAILABLE □ VISUAL AND AURAL PRIVACY WAS AFFORDED □ ONLY ONE EMPLOYEE AT A TIME WAS TESTED □ BAT REMAINED WITH EMPLOYEE FOR THE ENTIRE TIME CONNECTICUT DRUG AND ALCOHOL TESTING CONSORTIUM ...