EPASS Request Today's Date(Required) Month Day Year Type of Testing(Required) DOT Non-DOT Testing Company(Required)Employee Name (Last, First)(Required)Date of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employee Driver's License Number(Required)State Issued(Required)Employee Phone Number(Required)Employee Email(Required) Reason for Test(Required) Pre-Employment Random Reasonable Suspicion/Cause Post-Accident Return to Duty Follow-up Other Type of Test(Required) Drug Alcohol Both Send to Driver(Required) Text to phone Email Don't notify driver Test Location (Zip Code, City, State)(Required)D.E.R. Email(Required) PhoneThis field is for validation purposes and should be left unchanged. Δ
2032 East Kearney Suite 108
Springfield, MO 65803
M-F 8am to 4pm
