Consortium Enrollment Form

Select your DOT Mode

Membership fee is for each safety sensitive employee position. The annual membership fee includes the cost of all random testing charges for the year.
DOT mode*
Number of FMCSA Employees:*
Number of FAA Employees:
Number of FRA Employees:*
Number of Maintenance of Way (FRA) Employees:*
Number of FTA Employees:*
Number of PHMSA Employees:*
Number of USCG Employees:*
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Number of Employees
FMCSA: Motor carrier companies with 1-5 Employees are charged at a per Employee rate of $90.
To benefit FMCSA companies with 6 or more Employees our pricing structure is $195.00 per company, plus $35.00/employee
FAA: Aviation carrier companies are charged $195.00 per company plus at a per Employee rate of $25.
FAA: Aviation carrier companies are charged $195.00 per company plus at a per Employee rate of $25.
FRA: Railroad companies with 1-5 Employees are charged at a per Employee rate of $90.
To benefit FRA companies with 6 or more Employees our pricing structure is $195.00 per company, plus $35.00/employee
FRA: Maintenance of Way companies with 1-5 Employees are charged at a per Employee rate of $90.
To benefit Maintenance of Way (FRA) companies with 5 or more Employees our pricing structure is $195.00 per company, plus $35.00/employee
FTA: Transit companies with 1-5 Employees are charged at a per Employee rate of $90.
To benefit FTA companies with 6 or more Employees our pricing structure is $195.00 per company, plus $35.00/employee
PHMSA: Pipeline companies with 1+ Employees are charged $195 per company at a per Employee rate of $35.
To benefit PHMSA companies with 9 or more Employees our pricing structure is $195.00 per company, plus $35.00/employee
USCG : Coast Guard companies with 1-5 Employees are charged at a per Employee rate of $90.
To benefit USCG companies with 6 or more Employees our pricing structure is $195.00 per company, plus $35.00/employee
To benefit Pipeline companies of all sizes our pricing structure is $195.00 per company, plus $35.00/employee
To benefit Aviation companies of all sizes our pricing structure is $195.00 per company, plus $35.00/employee

FMCSA COMPANY INFORMATION
FAA COMPANY INFORMATION
FRA COMPANY INFORMATION
MOW COMPANY INFORMATION
FTA COMPANY INFORMATION
PHMSA COMPANY INFORMATION
USCG COMPANY INFORMATION
Company Name
Company street address
City
State
Zip
- How would you like to receive reports? -
REPORTING CONTACTS
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User Email
Primary Reporting Contact Email*
Enter an email address where you'd like to receive your receipt of this transaction.
First Name
Last Name
Title
Email
Phone & extension
Fax
How would you like to recieve reports?
- By Email
- By Secure Fax
EMPLOYEES
First Name
Last Name
Last 5 digits of SSN
Safety Sensitive Position
Safety Sensitive Position
Safety Sensitive Position
Safety Sensitive Position
Safety Sensitive Position
Safety Sensitive Position
Safety Sensitive Position
Need a pre-employment drug screen?
- No
- Yes -$55
Driver’s License # and State Issued
Driver’s License
State Issued
All DOT modes require a pre-employment drug screen for all employees including owner/operators. Pre-employment test is not required if the employee has been enrolled in another DOT random pool for your company within the last 30 days and/or you meet the pre-employment test exemption criteria of your DOT mode. Collection site location and required chain-of-custody form to complete the requested pre-employment drug screen will be mailed to you within five business days.
GENERAL INFORMATION
Need a DOT drug & alcohol testing policy?
Policy will be sent to you within two business days.

Do you need supervisor/employee training? We offer an on-line training option. At the end of this enrollment you will be given a link to register and complete on-line training

D.O.T. Drug & Alcohol
Testing Management Agreement

Mode: FMCSA

This Consortium Agreement ("Agreement") is made and effective between The Oschmann Organization, Inc. ("Consortium") and Company ("Member").
- Purpose Consortium and Member enter into this Agreement for the purpose of meeting the requirements for a Random Drug & Alcohol Testing Program as ordered by the Department of Transportation regulations.
- Definitions Covered Services: Those services provided to Member to include the following:
  - Notification to Member of safety sensitive employee(s) selected for random drug and/or alcohol test
  - Random drug test fees (Laboratory, Collection at contracted facility during normal business hours, & MRO)
  - Random alcohol test fees (Screening & Confirmation at contracted facility during normal business hours)
  - Reminder service to Member's D.E.R. of employees that have not submitted to random testing
  - Semi-Annual statistical report as mandated by 49 CFR Part 40.111
  - Preparation of Annual MIS Report in compliance with applicable mode's regulations
  Fee for Service: Those services which are not benefits under Covered Services are the financial responsibility of the Member.
  Medical Review Officer (MRO): Means a licensed physician responsible for receiving laboratory results generated by an employer's drug testing program.
  Program Requirements: Means conditions established in this agreement and followed by participants in order to receive covered services.
- Obligations
  - Consortium will provide or arrange for the provisions of Covered Services to Member.
  - Consortium will provide random drug and alcohol testing and all necessary documentation and notification.
  - Consortium will provide Covered Services at contracted facilities
  - The Member will provide policy and procedures regarding drug & alcohol testing in the workplace. Member will provide updated lists of covered employees.
  - Member will maintain files consistent with program compliance and assign a company drug & alcohol representative to work with Consortium.
  - Member agrees that all drug and alcohol tests be handled and managed by Consortium for Member's employees. Should the Member have an employee tested outside of the Consortium, the Member will forward all results to the Consortium within 48 hours of receipt.
  - Member agrees that Consortium acts as an intermediary to transmit drug and alcohol testing information from the MRO to the Member in accordance with 49 CFR Part 40.345(a).
  - Member agrees that should they not perform tests as requested, follow the Consortium procedures, or violate this Agreement the Member can be expelled from the Consortium. Should the Member be expelled from the Consortium the Member may be reported to the applicable Department of Transportation agency for non-compliance as required by law.
- Fees
- Compliance with Department of Transportation (D.O.T) Regulations Both Consortium and Member agree to be bound by and comply with all provisions of applicable state and federal laws and regulations.
- Term The term of this Agreement shall commence on the effective date of this Agreement and shall continue in full force and effect for a period of one year. This Agreement will automatically renew each year unless Consortium receives 30-day written notification of cancellation by Member.
- Company Designated Employer Representative (D.E.R.)
  
  The following individual(s) is/are designated the Primary representative for the Member. Should Member wish to change representatives please supply those names to the Consortium in writing.
- Reporting Method of Results
  Member prefers that results be reported out
- Does Member Need A DOT Drug & Alcohol Testing Policy?
- Employees Subject to Testing
  
  The following employees have been enrolled. Member and Consortium understand that these employees may be changed at any time. Member agrees that fees will be assessed for increased employee positions on a prorated basis to the next anniversary date:
- Notices
  Any notice required by this Agreement or given in connection with it shall be given to appropriate party in person, by phone, mail, facsimile, or any recognized delivery service.
  If to Consortium:
  1037 South Alvernon Way
  Suite 150
  Tucson, AZ 85711
  tel: 520-745-1029
  fax: 520-745-1187
  
  If to Member:
- Hold Harmless & Indemnification
  Company agrees to hold harmless and indemnify Consortium for any claims made by Company, Company's employee, or former employee of Company claiming an alleged improper, illegal, and/or unauthorized disclosure(s) was made by Consortium to Company or on Company's behalf pursuant to the requirements of this Agreement.
  
  Company agrees to hold harmless and indemnify Consortium for any and all claims made by Company's employees rising out of or in conjunction with any erroneous, incorrect, and/or incomplete information Company is required to provide to Consortium under this agreement.
- Final Agreement
  This Agreement terminates and supersedes all prior understandings or agreements on the subject matter hereof. This Agreement may be modified only by a further writing that is duly executed by both parties.
  
  All sales final.
- Governing Law
  This Agreement shall be construed and enforced in accordance with the laws of the State of Arizona.
  
  All parties to this Agreement agree that any and all claims of breach of contract arising under or out of this Agreement shall be fully and finally settled by mandatory binding arbitration under the rules promulgated by the American Arbitration Association. Such mandatory binding arbitration will be held in the city of Tucson, Arizona. Costs for binding arbitration itself will be split equally between the parties. All parties will bear their own attorney fees. All decisions of arbitrator are binding, final, and enforceable in any court of competent jurisdiction.
- I accept this agreement and validate that I am the Authorized representative for Member.
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Price
Total
$0.00
Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address
Street Address Address Line 2 City State ZIP Code

Select your DOT Mode

Driver’s License # and State Issued

D.O.T. Drug & AlcoholTesting Management Agreement

Mode: FMCSA

Get Compliant Now

D.O.T. Drug & Alcohol
Testing Management Agreement