In accordance with Section 112. 0455(12)(d), Florida Statutes and Section 440. 102(9)(d), F. S., each forensic toxicology laboratory licensed to perform Florida Drug-Free Workplace Testing under Section 112



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Florida Drug-Free Workplace

Forensic Toxicology Laboratory



Monthly Statistical Reporting


In accordance with Section 112.0455(12)(d), Florida Statutes and Section 440.102(9)(d), F.S., each forensic toxicology laboratory licensed to perform Florida Drug-Free Workplace Testing under Section 112.0455, F.S. or Section 440.102, F.S. shall submit to the Agency for Health Care Administration a monthly report with statistical information regarding the testing of employees and job applicants.
Information reported must not reveal the name of persons tested or the employer’s identity.
Reports must be submitted to the Agency for Health Care Administration no later than 14 working days after the end of a reporting month. Reporting is required even if no Florida Drug Free Workplace testing has been done for the reporting month. (Reference Section 59A-24.006(15)(b), Florida Administrative Code)
Failure to submit a statistical report as required shall result in administrative action up to and including revocation of licensure. (Reference 59A-24.006(12)(a), Florida Administrative Code)


Reporting Month

     

Year

     




Forensic Toxicology Laboratory Name

     

License Number: T

     

Physical Address

     

     

     

     

City

     

State

     

Zip

     






Total number of specimens received for testing

     

Total number of specimens received but not tested

     

Total number of specimens that tested positive on initial screening

     

Total number of specimens confirmed and report as positive for:

     

Alcohol

     

Amphetamines (amphetamine, methamphetamine)

     

Cannabinoids (11-nor-Delta-9-tetrahydrocannabinol-9-carboxylic-acid)

     

Cocaine (benzoylecgonine)

     

Phencyclidine

     

Methaqualone

     

Opiates (Codeine, Morphine, 6-Acetylmorphine)

     

Barbiturates

     

Benzodiazepines

     

Methadone

     

Propoxyphene

     



Mail reports to:

Laboratory Licensure Unit

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop #32

Tallahassee, Florida 32308

or e-mail to:

LABSTAFF@ahca.myflorida.com


AHCA Recommended Form

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