Get the free CG-719P.PDF. DOT/USCG Periodic Drug Testing Form (Optional CG-719P)

DEPARTMENT OF HOMELAND SECURITY OMB No. 16250040U. S. Coast Guarded. Date: 03/31/2021DOT/USCG PERIODIC DRUG TESTING FORM (OPTIONAL CG719P) Who must submit this form? INSTRUCTIONS: This form MAY be

How to fill out cg-719ppdf dotuscg periodic drug

How to fill out cg-719ppdf dotuscg periodic drug

1. To fill out the CG-719P (DOT/USCG Periodic Drug Testing Form) point by point, follow these steps: 1. Start by providing your personal information, such as your name, social security number, and date of birth.
2. Proceed to section A, where you will need to enter information about your employer, vessel name, U.S. Coast Guard mariner reference number, and DOT drug testing household urine identification number.
3. In section B, indicate the date the urine specimen was collected and the type of specimen collected (e.g., observed, unobserved).
4. Then, select the appropriate box to indicate whether you have any medical conditions that may require the use of prescription or non-prescription medications.
5. If you have selected 'Yes' in the previous step, provide the necessary details of your medical condition and the medication you are currently taking.
6. In section C, provide the names and addresses of any health care professionals who have treated you within the past two years.
7. Section D requires you to list all medications you are currently taking, including prescription, non-prescription, and over-the-counter drugs.
8. Indicate the frequency and dosage of each medication listed in section D.
9. If you have any additional comments or information regarding this form, you may include it in section E.
10. Finally, sign and date the form to certify that all the information provided is true and accurate.
11. Remember to carefully review the form before submitting it to ensure all the required information is provided.

Who needs cg-719ppdf dotuscg periodic drug?

1. The CG-719P (DOT/USCG Periodic Drug Testing Form) is required for mariners who are subject to drug testing under the regulations of the U.S. Department of Transportation (DOT) and the U.S. Coast Guard.
2. This includes mariners who serve on vessels that are subject to the jurisdiction of the Coast Guard, such as commercial vessels, passenger vessels, and certain types of fishing vessels.
3. The form is used to document the results of periodic drug testing and to provide information about any current use of medications or medical conditions that may impact drug test results.
4. It is important for mariners to fill out this form accurately and truthfully to comply with the drug testing requirements and ensure the safety of themselves and others on board.

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What is cg-719ppdf dotuscg periodic drug?

cg-719ppdf dotuscg periodic drug is a form used by the United States Coast Guard (USCG) to collect information on drug use by individuals who are required to hold a Merchant Mariner Credential (MMC).

Who is required to file cg-719ppdf dotuscg periodic drug?

Individuals who hold a Merchant Mariner Credential (MMC) are required to file cg-719ppdf dotuscg periodic drug.

How to fill out cg-719ppdf dotuscg periodic drug?

To fill out cg-719ppdf dotuscg periodic drug, individuals must provide information on their drug usage history and certify that the information provided is accurate.

What is the purpose of cg-719ppdf dotuscg periodic drug?

The purpose of cg-719ppdf dotuscg periodic drug is to ensure that individuals holding a Merchant Mariner Credential (MMC) are not engaging in drug use that could endanger themselves or others while on duty.

What information must be reported on cg-719ppdf dotuscg periodic drug?

Information such as the individual's drug use history, any drug-related convictions, and any drug counseling or rehabilitation programs attended must be reported on cg-719ppdf dotuscg periodic drug.