Positive/Refused Drug/Alcohol Test Report

These forms are used to report positive drug or alcohol tests, or refusals to take the tests. The reports must be submitted to us within 3 business days of the confirmed test.

Instructions

Fill out the form completely, and print it on white paper.

If you are: Use this form:
A medical review officer or
breath alcohol technician		 Adobe PDF iconPositive/Refused Drug/Alcohol Test Report
An employer or motor carrier Adobe PDF iconPositive/Refused Drug/Alcohol Test Report by Employer

 

Please mail or fax the completed report to:

Mandatory Suspension
Department of Licensing
PO Box 9030
Olympia, WA 98507-9030
Fax: (360) 570-7826