END OF YEAR RANDOM DATA END OF YEAR RANDOM TESTING REPORT END OF YEAR RANDOM TESTING REPORT RANDOM COORDINATOR REP * Today's Date * MM DD YYYY YEAR * Company Name: * DOT OR NON-DOT? DOT (DEPARTMENT OF TRANSPORTATION) NON-DOT Testing Mode Total Number of Employees * (started off with) Employees added * Did the company request Initial testing before random testing? * Yes, we did initial testing No (No initial testing) Initial Testing conducted (If Applicable) ****** QUARTER 1 ****** January February March ****** QUARTER 2 ****** April May June ****** QUARTER 3 ****** July August September ****** QUARTER 4 ****** October November December Any removals? * Yes No Removed Any refusals? * Yes No Refused Has NOT tested this year Estimate current total employees Additional data to be added Thank you!