Get Tn Lb-1111 2016-2026

The TN LB-1111 form is an essential document for employers participating in the Drug-Free Workplace Program in Tennessee. This guide will provide you with clear steps to effectively complete the form online, ensuring your application is accurate and compliant.

Follow the steps to fill out the TN LB-1111 form online

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editing tool.
2. Begin by selecting the appropriate application type at the top of the form: either 'New application,' 'Renewal application,' or 'Changed Insurance Carrier.'
3. Fill in the company name and Federal Employer Identification Number (FEIN) in the designated fields.
4. Provide the mailing address, including city, state, and zip code, ensuring all details are correct for proper communication.
5. Enter the business address, again including city, state, and zip code. This should reflect the location where business is conducted.
6. Input the phone number, fax number, and email address where you can be reached for any communication regarding the application.
7. Identify the Substance Abuse Program Administrator's name to indicate who is responsible for the program.
8. Indicate the nature of your business and total number of full-time and part-time employees in the appropriate fields.
9. List your current Workers’ Compensation Insurance Carrier’s details as required.
10. Circle the lab certification that applies: SAMHSA, CAP-FUDTAP, or Other.
11. Provide the name of the testing laboratory along with its city, state, and zip code.
12. List the name and phone number of the Medical Review Officer (MRO) who oversees your program.
13. Answer the questions regarding employee training and acknowledgment of the drug-free policies, selecting 'Yes' or 'No' as applicable.
14. Fill in the effective date of your program.
15. For renewal applicants, indicate the number of tests performed in the past 12 months for the specified categories and note the number of positives.
16. Lastly, provide the signature of the Owner/Officer, print their name, and the date of signing at the end of the form.
17. After completing all sections, review the form for accuracy, save your changes, and proceed to download, print, or share as needed.

Start filling out the TN LB-1111 online today to ensure your compliance with the Drug-Free Workplace Program.