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Please fill out the information to the best of your knowledge. The Personal Experience Field for is to be marked 'YES', if indeed, you have personal experience any type of drug testing with this company. The comments field is reserved for any additional comments that you will to make concerning this company. This would be a good place to indicate and experience with this company concerning their drug testing practices. As always, we do not record any personal information concerning this submittal.

Name of Company
Address (If Known)
Company City
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Country	United States Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands, The Cape Verde Cayman Islands Central African Republic Chad Chile China, Peoples Republic Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic, The Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Republic Guinea-Bissau Guyana (British) Haiti Honduras Republic Hong Kong Hungary Iceland India Indonesia Iran Ireland, Republic of Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Republic of Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru, Republic of Nepal Netherlands, The Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines, The Poland Portugal Puerto Rico Qatar Reunion, Island of Romania Russian Federation, The Rwanda Saipan Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Barthelemy St. Eustatius St. Kitts St. Lucia St. Maarten St. Vincent Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Western Samoa Yemen Yugoslavia Zaire Zambia Zimbabwe
Business Type	Select Business Type Manufacturing Finance/Banking Insurance/Legal Government Education Health Care Wholesale/Retail Trade Transportation Utilities/Petroleum/Gas Architecture/Engineering Agriculture Non-Profit Consultant Software Developer Web Hosting Service Internet Service Provider Internet VAR Bell, National, Carrier Local Telco or Cable Co Computer/Software Mfg Network/Comm Equip Mfg Cable TV Broadcast TV/Radio Publishing Entertainment Industry Advertising/Public Relations Mining Unknown                          Frequency of Test
Drug Test Used	Select Test Urine Blood Hair Salvia Sweat Urine/Blood Roche Test Cup American Bio Medica Test Cup Other Test/Indicate in Comments              Select Frequency Pre-Employment Only Random - Every 30 Days Random - Every 30 Day to 3 Months Random - Every 3 to 6 Months Random - Every 6 months to 1 year
Personal Experience	Pick One Yes No
Laboratory	Other
Testing characteristics	Requires ID Split Sample Temp Check Dye in Toilet Faucets Sealed Door Closed Door Cracked Door Open
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