DATJ 153 Assessor Checklist for Obtaining Urine/Breath Samples

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• Conducted on

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• Patient Name

Obtaining a Urine/Breath Sample

The Pre-test Check (Urine Sample)

• To ensure that you are prepared for the urine test, confirm that the following checks are carried out before testing commences.

• Are a minimum of 4 x drug cup packs available?

  Confirm

• Are the cups sealed in protective wrapping with no evidence of tampering and all in date?

  Confirm

The Pre-test Check (Breath Sample)

• Do you have an alcohol breath tester with sufficient battery life (See icon on display)

  Yes

  No

• Are a minimum of 6 x mouthpieces available?

  Yes

  No

Positive test laboratory confirmation test packs

• Following a positive test, is the chain of custody lab sample pack available pack intact for UKAS/INAB laboratory confirmation?

  Yes

  No

• If following a positive test, it is a requirement to have the results verified by a UKAS/INAB certified laboratory. It is possible to continue with the test without, but you must refrigerate the sample for no more than 72hrs whilst an emergency order is delivered.

  Yes

  No

  N/A

General

• Do you have a room for a private discussion?

  Yes

  No

• Do you have disposable gloves and other PPE available to perform the test.

  Confirm

• Has the minimum standards for social distancing and hygiene been achieved?

  Confirm

• Has the employee eaten any food within the last 30minutes?

  Yes

  No

• For the breath test to be accurate, at least 30 minutes must have elapsed before a sample of breath can be obtained.

• Do you have a copy of QSHE 154 Employee information sheet? (A copy must be shared with the employee)

  Confirm

• Do you have a copy/access to QSHE 155 Consent form/template?

  Confirm

• Is the individual being tested known to the assessor or co-assessor?

  Yes

  No

• An official form of photo ID is required. This can be in the form of a Driving Licence/Passport or other official document.

  Media

Procedural explanation with employee regard to collecting a urine sample!

• Explanation given that failure to provide a sample or consent will be recorded

  Confirm

• Explanation given to the employee that if a coloured line is registered in the "Control" box, the test will be valid.

  Confirm

• 

• Explanation given to the employee that if a coloured line "Fails" to register next to any of the test categories, the test is "POSITIVE"

  Confirm

• 

• Explanation given to the employee that if a sample provides a "Positive" result, the sample will be sent to a UKAS/INAB accredited laboratory for analysis for confirmation of the test results.

  Confirm

Procedural explanation with employee regard to collecting a breath sample!

• Explanation given to the employee that failure to provide or consent to a sample will be recorded.

  Confirm

• Explanation given to the employee that If the sample reads 000%BAC, then the test is "Negative"

  Confirm

• Explanation given to the employee that if the sample reads ABOVE 000%BAC then a further sample will be taken 20 minutes later and if the result is above 000% BAC, the result is confirmed.

  Confirm

• I confirm that I have provided the patient with all the relevant information and were applicable answered any questions.

• Signature of Assessor

  Sign

• Signature of Co-Assessor

  Sign

• Signature of Employee

  Sign