Get Form: Dpa 177b - State Of California - Dpa Ca

Filling out the Form Dpa 177b for drug and alcohol testing in California is an essential procedure for employees and supervisors. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the Form Dpa 177b.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online document editor.
2. In Box 1, select the reason for the test by checking the appropriate box. Options include 'Follow Up', 'Post Accident', 'Pre-Employment', 'Random', 'Reasonable Suspicion', and 'Return to Duty'. Additionally, indicate the type of test to be performed by checking 'Urine Collection' or 'Breath Alcohol Test'.
3. In Box 2, enter the full name of the employee to be tested, including their last name, first name, and middle initial. Next, input the employee identification number and the CBID relevant to CDCR, selecting one of the given options: R06, S06, or M06. Finally, specify the agency.
4. In Box 3, provide the name and address of the collection site where the test will be conducted. Ensure that these details are accurate to avoid any confusion.
5. In Box 4, fill in the telephone number and contact person at the collection site. Additionally, list the department ordering official, their phone number, and include their signature and the date of signing in the designated fields.
6. After filling out all the necessary sections of the form, review the information for accuracy. Once confirmed, you can save your changes, download a copy, print it, or share it as required.

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