Collections

Sample Collection Booking Form

This is the booking form for our UK-wide sample collection network. Where possible please allow 48 hours when booking a collection. For emergency response collections (within 24-48 hours), please utilise our 24/7 callout service on 01283 243321 (please only use this number for emergency callouts or B sample confirmation requests).

Please complete the following form to initiate a sample collection:

Company Name

Company name to be recorded on chain of custody form (if different from above)

Name of Requestor

Email of Requestor

Telephone Number of Requestor

Address for Collection (include postcode)

what3words Location (if known)

Onsite Contact Name

Onsite Contact Telephone Number

Alternative Onsite Contact Name

Alternative Onsite Contact Telephone Number

Any Access Issues (e.g. parking or induction required)

Email Address for Result Reporting

Purchase Order (PO) Number

Please note: 48 hours' notice is required for pre-scheduled bookings. For emergency response (within 48 hours), please call our collections line on 01283 243321.

Date Collection Required

Time Collection Required (HH:MM, 24-hour format)

Number of Donors

Reason for Test

Sample Type?

Sentinel Upload Required? (Network Rail PTS only)

Breath Test Required?

Breath Limit

Specify Other Breath Limit (if selected above)

Please ensure the donors bring suitable photographic ID to the testing and additionally, for any Network Rail PTS testing, they must be in possession of their National Insurance Number and Sentinel Number. Acceptable identification includes a passport, Driving Licence that includes a photograph) or Sentinel card (for Rail). Photocopies of ID documents are not acceptable. However, in the event of no ID being available, donors may be vouched for by a suitable manager.

The donor must sign to consent to the test before commencing and should have nil by mouth in the 15 minutes preceding the test including cigarettes, vapes or e-cigarettes.

As the client, you will need to provide a private room with a table and at least two chairs for oral fluid and breath/alcohol testing and if urine testing is required, a nearby toilet facility with hand washing facilities. Access to these facilities should be restricted to MHE for the duration of the testing process.

By submitting this form, you are confirming that the following facilities are available: A waiting area. A private room with table and chairs where Chain of Custody documentation can be completed and medication can be disclosed confidentially. A suitable toilet facility (ideally adjoining the private room) which can be secured. Hand washing facilities (ideally outside of the toilet cubicle used for the collection). Emergency exits, safe assembly points and the location will stock and maintain appropriate first aid materials for both donor and collector needs.

_{SOP018F1 – Sample Collection Booking Form V1 – authorised by C. Evans, Page 1 of 1.}

Sample Collection Booking Form

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