Home | Services | Coverages | Newsletters | Claims Management | Training & Risk Management | About Us | Links | Minutes/Agendas | Contact Us

Personal Information Form
DOT Drug and Alcohol Testing Program

In order to begin the test scheduling and tracking program for all employees subject to the DOT Drug and Alcohol Testing Program, the following information is required for each employee:

Employee Social Security Number:
Employee Name (Last, First & M.I.):
Occupation/Job or Position Title:
Assigned Department:
Employee DOT Education Date:
Employee Type:
Alternate Supervisor:
Date of Birth:
Sex: Male Female

© 2009 CRMA - California Risk Management Authority. All Rights Reserved.
1430 W Herndon Ave. Fresno, CA 93711
559-476-2999 - FAX 559-476-2933