Drug and Alcohol records reporting form (web #1)

Pilot Records Improvement Act of 1996/ Pilot Record Database

Drug and Alcohol Records IC list

Drug and Alcohol records reporting form (web #1)

OMB: 2120-0607

Document [docx]
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Data Element

Description

Reporting entity designator:

Designator (or PRD equivalent) of the air carrier or operator entering the record (automatically populates with assigned credential)

Reporting entity name:

Name of the certificate holder or operator as it appears on the certificate or is otherwise recorded in the FAA records. (automatically populates with assigned credential)

Other DOT Agency entity name*:

  • This is the source of records that are reported to the FAA by employers regulated under another DOT Agency where an individual worked as a pilot.

  • [Text field]

Regulating Agency (Non-FAA)*:

    • FMCSA – Federal Motor Carrier Safety Administration

    • FRA – Federal Railroad Administration

    • FTA – Federal Transit Administration

    • PHMSA – Pipeline & Hazardous Material Safety Administration

    • USCG – U.S. Coast Guard

Pilot certificate number:

Certificate number of the pilot receiving the action

Pilot last name:

Name of the pilot as it appears on their certificate

Date of test or occurrence:

Date

Record Type:

Valid options:

  • Drug Test

  • Alcohol Misuse

Report Type*:

See Table B-2 (these options change based on selection above)

Type of Test*:

See Table B-2 (these options change based on selection above)



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMorris, Christopher (FAA)
File Modified0000-00-00
File Created2024-07-23

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