• According to the US Department of Transportation rules and regulations a company can have a service agent provide or coordinate the provision of a variety of drug and alcohol testing services to employers. Included in these regulations are requirements that the providers of the drug and alcohol C/TPAs and MROs are certified according to the standards and drug testing procedures required under 49 CFR Part 40. KTHC is compliant with all requirements required under 49 CFR Part 40. If your company is electing to have KTHC as your DOT Service Agent, Complete the form below.
  • Contract Term January 1 to December 31, 2019. This agreement expires 12/31/19 and must be renewed in writing for subsequent periods.
  • *Please note that KTHC sends results, billing and informational documents to your email address. We request that your email be kept secure due to sensitive information that may be transmitted.
  • Random Selection Provider

  • Please select ‘yes’ if you would like for us to pull your random drug screens and alcohol selections. By selecting YES, Motor carrier agrees to send a complete list of all drivers to KT Health Clinic when requested. Minimum will be each six months – December and June—for random selection)
  • Please list up to three Designated Employee Representatives that we can discuss drug screen results with:
  • • Each motor carrier is responsible to meet the minimum requirement for random testing based on DOT guidelines. KTHC reserves the right to terminate this agreement with companies that do not actively participate in the DOT consortium requirements. Signing below indicates your agreement and understanding.
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