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Drug Testing Chain of Custody Forms

Federal Drug Testing
Sample Custody and Control Form

Federal Drug Testing Chain of Custody Form (front)
(front preview)

 

Federal Drug Testing Chain of Custody Form (back)
(back preview)

 

 

 

Chain of Custody format

  • OMB No. 0930-0158
  • Continuous - 9.5 " x 11" (8.5 " x 11" after detaching)
  • 5 Part set
    • Copy 1 Test Facility copy
    • Copy 2 Medical Review Officer copy
    • Copy 3 Collector copy
    • Copy 4 Employer copy
    • Copy 5 Donor copy
  • 2 Built-in Specimen Labels on Copy 1
  • Form sets have Specimen ID Numbers
  • Each form set has its own Specimen ID Number
  • Same Specimen Number is Bar Coded and Arabic-numbered on each of the two built-in Specimen Labels (A and B)
  • Built-in Specimen Labels (A and B) are to be affixed as specimen bottle seals.
  • Carbonless Transfer - computer printing, and hand-writing, appear on all parts

 

Please email us, call us at 1-800-982-3676 or fill out the form below to request a custom Chain of Custody quote. Please let us know if you have logo, ink color, company imprint, or other special requirements. (Minimum quantity is 2,500)

 

Common Questions:

What is chain of custody?

What is a chain of custody form?

Does a chain of custody count as a drug test?


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Request Custom Chain of Custody Quote

 

 

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Continuous (pin feed) or glued set *
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White or color of copies? *
Page size? *
Sequential numbering *
Barcode? *
Built in label(s)? If so, size and location *
Marginal Words *
Ink color - Front print? *
Ink color - Back print? *
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Quantity required? (2,500 minimum) *
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First Name *
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They Said... more
With a small business, I don't need many year end employee forms. The smaller quantities Burris offers sure makes it convenient and cost effective for me!

Nancy W., Rental Equipment Company

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