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PH MSA Release of Information Form 49 CFR Part 40 Drug and Alcohol Testing Appendix J Section I. To be completed by the new employer, signed by the employee, and transmitted to the previous employer:

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How to fill out phmsa release of information

01

First, make sure you have the PHMSA release of information form.

02

Gather all the necessary information that needs to be included in the release of information form.

03

Start by filling out your personal information, such as your name and contact details.

04

Provide a brief explanation of the purpose for releasing the information.

05

Specify the type of information you are releasing, such as medical records, employment history, or accident reports.

06

Include the date range or specific incidents for which the information is being released.

07

If applicable, indicate any restrictions on the release of the information.

08

Sign and date the form to confirm your consent to release the information.

09

Ensure that you have provided all the required information and double-check for any errors or omissions.

10

Submit the completed PHMSA release of information form to the appropriate recipient or authority.

Who needs phmsa release of information?

01

Individuals who want to authorize the release of their information to PHMSA or other related entities.

02

Employers or organizations involved in accidents or incidents that need to provide information to PHMSA.

03

Medical professionals or healthcare providers who need to share relevant medical records with PHMSA.

04

Any individual or company involved in an inspection, investigation, or enforcement action carried out by PHMSA.

05

Anyone who has voluntarily offered to provide information to PHMSA for regulatory compliance or other purposes.

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