Drug / Alcohol Test Notification Form - KELMAR Safety, Inc.
KELMAR Safety, Inc. is the Employee Safety Training, Department of Transportation (DOT) Compliance Specialist and Pre-Employment Screening department your company needs to reduce its liability and improve its overall performance McAfee SECURE sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams
KELMAR Safety Inc.  
 
 

Drug / Alcohol Test Notification Form

Please use the following form to notify us when a donor has been sent to take a drug test at a remote location.

By completing this form below, KELMAR can proactively anticipate and track results to insure that you are notified of the results in a timely manner.

You may also contact the Drug Testing Department by calling 317-468-0730

Your Contact Information:
First Name:  Last Name: Company Name:
Company Location: Daytime Phone: Your Email Address:

Donor Information:
First Name: Last Name: SSN:
Date Sent:

 Clinic Information:
Clinic Name: Address:
State: Zipcode:
Phone: CCF Number


Choose the type of test(s) below that apply:
 
 
Choose the test(s) below that apply:
 
 
 
 

 Comments Section:
Comments: