DA Form 7412 Condition of Employment for Certain Civilian Positions Identified Safety-Sensitive Under the Department of Transportation, Federal Highway Administration Rules on Drug and Alcohol Testing

DA Form 7412 - also known as the "Condition Of Employment For Certain Civilian Positions Identified Safety-sensitive Under The Department Of Transportation, Federal Highway Administration Rules On Drug And Alcohol Testing" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7412 - was last revised on November 1, 2001. Download an up-to-date fillable PDF version of the DA 7412 down below or look it up on the Army Publishing Directorate website.

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CONDITION OF EMPLOYMENT FOR CERTAIN CIVILIAN POSITIONS IDENTIFIED SAFETY-SENSITIVE UNDER THE
DEPARTMENT OF TRANSPORTATION, FEDERAL HIGHWAY ADMINISTRATION RULES ON DRUG AND ALCOHOL
TESTING
For use of this form, see DA PAM 600-85; the proponent agency is ODCSPER
1. FROM
2. TO (Employee name, title, series, and grade)
3. NOTICE TO APPLICANT OR CURRENT EMPLOYEE OF RANDOM DRUG TESTING COVERED UNDER THE DEPARTMENT OF
TRANSPORTATION, FEDERAL HIGHWAY ADMINISTRATION RULES ON DRUG AND ALCOHOL TESTING
The Omnibus Transportation Employee Testing Act of 1991 (Public Law 102-143) requires alcohol and drug testing of
safety-sensitive employees in the motor carrier industry. On February 15, 1994, the U.S. Department of Transportation
(DOT ) and the Federal Highway Administration (FHWA) issued final rules requiring alcohol and drug testing of
drivers required to have a commercial driver's license (CDL).
A.
Your position, or the position for which you have applied, meets the criteria for inclusion in the alcohol and drug testing
program mandated by DOT. It is mandatory for your continued employment in this position that you refrain from the
misuse of alcohol and the use of illegal drugs and submit to alcohol and drug testing when directed.
B.
If you are an applicant and fail to sign this notice, you will not be selected for the position. If you sign this notice and
later in the selection process refuse to submit to an alcohol and/or drug test, or if alcohol misuse or illegal drug use is
detected through a verified applicant alcohol test or positive drug test you will not be selected for the position. If
selected, you will be subject to random alcohol and drug testing on an unannounced basis as a condition of continued
employment.
C.
If you are currently in an Army position covered by the DOT rules, you may be subject to random alcohol and drug
testing on an unannounced basis at any time following the receipt of this notice.
D.
You will be allowed individual privacy while providing the urine specimen unless there is reason to believe the specimen
will be altered. The collection, handling, and testing of the urine sample will be conducted in accordance with
procedural guidelines in 49 CFR Part 40. The quality of both the alcohol and drug testing procedures is tightly
controlled to ensure the highest reliability. The test results will be handled with maximum respect for individual
confidentiality. If a positive drug test result is received, you will be given an opportunity to discuss the results with the
medical review officer and present information concerning a legitimate explanation for the confirmed positive test before
any administrative action is taken.
E.
If you refuse to submit to an alcohol or drug test, you will be subject to a range of administrative actions for failure to
meet the condition of employment. If illegal use is detected through a verified positive drug test result and or your
breath alcohol test exceeds alcohol prohibitions, you will be promptly removed from performing your safety-sensitive
functions and referred to the installation Substance Abuse Professional for evaluation and referral.
F.
You, as well as all other Department of the Army employees, may also be subject to testing due to reasonable
suspicion as part of a safety/accident investigation or as part of a follow-up to a rehabilitation and/or counseling.
G. Attached to this notice is information you are required to have. Additionally, your alcohol and drug testing
(name and telephone number)
liaison is
This person is the point of contact for any questions you may have about this program.
4. ACKNOWLEDGMENT OF RECEIPT:
Your signature below acknowledges that you have read and received a copy of this notice.
a. EMPLOYEE'S SIGNATURE
b. DATE (YYYYMMDD)
NOTE: If an employee refuses to sign the acknowledgment above, the supervisor must sign below, thereby certifying
that a copy of the notice was provided to the employee.
5a. SUPERVISOR'S SIGNATURE
5b. SUPERVISOR'S TELEPHONE NUMBER AND FAX NUMBER
5c. SUPERVISOR'S E-MAIL ADDRESS
5d. DATE (YYYYMMDD)
APD LC v2.01ES
DA FORM 7412, NOV 2001
CONDITION OF EMPLOYMENT FOR CERTAIN CIVILIAN POSITIONS IDENTIFIED SAFETY-SENSITIVE UNDER THE
DEPARTMENT OF TRANSPORTATION, FEDERAL HIGHWAY ADMINISTRATION RULES ON DRUG AND ALCOHOL
TESTING
For use of this form, see DA PAM 600-85; the proponent agency is ODCSPER
1. FROM
2. TO (Employee name, title, series, and grade)
3. NOTICE TO APPLICANT OR CURRENT EMPLOYEE OF RANDOM DRUG TESTING COVERED UNDER THE DEPARTMENT OF
TRANSPORTATION, FEDERAL HIGHWAY ADMINISTRATION RULES ON DRUG AND ALCOHOL TESTING
The Omnibus Transportation Employee Testing Act of 1991 (Public Law 102-143) requires alcohol and drug testing of
safety-sensitive employees in the motor carrier industry. On February 15, 1994, the U.S. Department of Transportation
(DOT ) and the Federal Highway Administration (FHWA) issued final rules requiring alcohol and drug testing of
drivers required to have a commercial driver's license (CDL).
A.
Your position, or the position for which you have applied, meets the criteria for inclusion in the alcohol and drug testing
program mandated by DOT. It is mandatory for your continued employment in this position that you refrain from the
misuse of alcohol and the use of illegal drugs and submit to alcohol and drug testing when directed.
B.
If you are an applicant and fail to sign this notice, you will not be selected for the position. If you sign this notice and
later in the selection process refuse to submit to an alcohol and/or drug test, or if alcohol misuse or illegal drug use is
detected through a verified applicant alcohol test or positive drug test you will not be selected for the position. If
selected, you will be subject to random alcohol and drug testing on an unannounced basis as a condition of continued
employment.
C.
If you are currently in an Army position covered by the DOT rules, you may be subject to random alcohol and drug
testing on an unannounced basis at any time following the receipt of this notice.
D.
You will be allowed individual privacy while providing the urine specimen unless there is reason to believe the specimen
will be altered. The collection, handling, and testing of the urine sample will be conducted in accordance with
procedural guidelines in 49 CFR Part 40. The quality of both the alcohol and drug testing procedures is tightly
controlled to ensure the highest reliability. The test results will be handled with maximum respect for individual
confidentiality. If a positive drug test result is received, you will be given an opportunity to discuss the results with the
medical review officer and present information concerning a legitimate explanation for the confirmed positive test before
any administrative action is taken.
E.
If you refuse to submit to an alcohol or drug test, you will be subject to a range of administrative actions for failure to
meet the condition of employment. If illegal use is detected through a verified positive drug test result and or your
breath alcohol test exceeds alcohol prohibitions, you will be promptly removed from performing your safety-sensitive
functions and referred to the installation Substance Abuse Professional for evaluation and referral.
F.
You, as well as all other Department of the Army employees, may also be subject to testing due to reasonable
suspicion as part of a safety/accident investigation or as part of a follow-up to a rehabilitation and/or counseling.
G. Attached to this notice is information you are required to have. Additionally, your alcohol and drug testing
(name and telephone number)
liaison is
This person is the point of contact for any questions you may have about this program.
4. ACKNOWLEDGMENT OF RECEIPT:
Your signature below acknowledges that you have read and received a copy of this notice.
a. EMPLOYEE'S SIGNATURE
b. DATE (YYYYMMDD)
NOTE: If an employee refuses to sign the acknowledgment above, the supervisor must sign below, thereby certifying
that a copy of the notice was provided to the employee.
5a. SUPERVISOR'S SIGNATURE
5b. SUPERVISOR'S TELEPHONE NUMBER AND FAX NUMBER
5c. SUPERVISOR'S E-MAIL ADDRESS
5d. DATE (YYYYMMDD)
APD LC v2.01ES
DA FORM 7412, NOV 2001

Download DA Form 7412 Condition of Employment for Certain Civilian Positions Identified Safety-Sensitive Under the Department of Transportation, Federal Highway Administration Rules on Drug and Alcohol Testing

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