Natacompliance - Compliance Assessment

Anti Drug & Alcohol Misuse Prevention Program Assessment Form

This form is a helpful tool in assessing the current status of your Drug & Alcohol Misuse & Prevention Program. While completing this form, if you have any questions, please call the NATA Compliance Services Hotline 800.788.3210. You can complete this form online. You can also download a printable copy (MSWord format) and email your completed form to info@natacompliance.com, or fax it to 800.788.3210, or mail it to NATA Compliance Services, 1325 Airmotive Way, Suite 204, Reno, NV 89502. This is not an audit, but simply an assessment which will be handled confidentially by NATA Compliance Services. By completing this form, you will be provided with assessment recommendations that are designed to assist you in improving the quality of your program and/or lowering your existing costs. At the very least, this form will guide you to probe into certain critical security areas that are either regulated or simply prudent business practice.

(* Required Field)
*Company:
*Address1:
Address2:
*City:
*State:
*Zip Code:
*Contact Name:
*Title:
*Email:
*Phone:
Fax:
FAA Certification:
Specify Other:
Total # of Employees:
# of Employees subjected to CHRC or need access to SIDA:
Average Annual Turnover Rate:

Do you have an FAA-Approved Drug Plan?	Yes No
If Yes, what is your Drug Plan Number?
Do you have a Drug-Free Workplace?	Yes No
Do you use a Consortium?	Yes No

SECTION 1 - PRE EMPLOYMENT:
Check all that apply	NON-DOT	Flight Crew	Flight Attend.	Flight Instr.	Aircraft Dispatch	Aircraft Maint Prev Maint	Aviation Screen.	Ground Security Coord	ATC
DOT Pre-employment Drug Test
Drug Free Workplace
Other (describe):

Do you conduct initial (Drug) training for Employees?	Yes	No
Do you conduct initial (Drug) training for Supervisors?	Yes	No
Do you conduct initial (Alcohol) training for Supervisors?	Yes	No
Does your training take at least 60 minutes each?	Yes	No
Describe how training is performed:

SECTION 2 - DURING EMPLOYMENT PERIOD:
How many reasonable suspicion tests did you perform in:	2001	2002
Do you conduct recurrent (Drug) training for Employees?	Yes	No
Do you conduct recurrent (Drug) training for Supervisors?	Yes	No
How often do you conduct your recurrent training?:
Describe your shift schedule:
Does your training cover all shifts?	Yes	No
Describe your process in selecting your employees for drug and alcohol random tests::
Describe how your employees are notified that they have been selected to submit to a random drug and/or alcohol test::
Does your MRO refer your employee to a Substance Abuse Professional (SAP) when applicable or does your MRO offer SAP service (face to face interviews)?:
Are there any other information you would like to add about your Anti-Drug and Alcohol Misuse Prevention Program or your Drug Free Workplace?:
How are confidential drug records maintained in compliance with 49CFR40 and Part 121/135 Appendices I & J and are they easily retrievable?:

How long do you keep records of negative results?	DOT	Drug-Free Workplace
How long do you keep records of positive results?	DOT	Drug-Free Workplace

SECTION 3 - GENERAL QUESTIONS:
Have you ever been audited?	Yes No
If so, what were you audited for and by whom and the results of the audit:
On a scale of 1 to 5 (with 5 being the best), how is your company's knowledge of the current regulations.	1 2 3 4 5

Who performs the AntiDrug and AMPP-related functions and how much time is required by each employee who oversees these functions?
	Name	Title	Hours per week	Hours per month
AntiDrug & AMPP Coordination
Training
Document/Records Management

SECTION 4 - SERVICE AGENTS:
Service	Vendor	Cost	Comment
Drug & Alcohol Test Collection
Laboratory
MRO
C/TPA
Random List Generation
Training
Drug & Alcohol History Check

SECTION 5 - ADDITIONAL NOTES:

Please note any additional comments: