Drug and Alcohol records reporting form (web #1)

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)