ELECTRICAL INDUSTRY
DRUG–FREE WORKPLACE
harrisondfwp.aibpa.com
NAME______________________________________ ID# __________________________ ACCOUNT # 1127
Date __________________ Employer __________________________________ TIME _______________
Please check the test type:
Pre-Employment
Random
Reasonable Suspicion
Post Accident
** Breathalyzer required for Reasonable Suspicion and Post Accident tests **
COMPANY: IBEW Local 48 and 970/NECA/ Periodic Drug Screening
Please bring this form with you at the time of your specimen collection. Remember the lab will need to see picture identification. Make
sure the collection site gives you your copy of the request/consent form as you will need to give a copy to the Union or your Employer
within 24 hours of notification to test. ** Once you have checked in you must stay to complete the process or it will be a
Updated 01/2011
refusal to test. Be prepared to complete the process in three hours or less. **
IMPORTANT: Are you on medications that may make your test positive?
You can speed the verification process if you take the following optional steps.
1) Write down your prescription on the collection form at your testing site!
2) Write down your daytime contact phone number.
You can keep your medications on file to make it easier. Call the Trust Office or visit the website to find
out how!
 Sites marked with  have Breathalyzer capabilities 
PORTLAND / GRESHAM / FAIRVIEW / THE DALLES/HOOD RIVER / ST HELENS
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COLUMBIA MEDICAL PLAZA: 5847 NE 122nd Ave, Suite 200 (122nd & Airport Way), Portland (503) 256-3401, M-F 8am-5pm,
(closed 12pm-1pm) 
LEGACY CENTRAL LAB: 1225 NE 2nd Ave, 1st floor, (East of Rose Garden Arena, close to MAX), Portland (503) 413-5000, M-F
24 hrs, Sat 8:00am- 4:30pm, walk-in  No breathalyzer after 7pm
OCCUPATIONAL CONSULTANTS NORTHWEST (Washington Bldg): 9370 SW Greenburg Rd, #602, Portland (503) 246-4104, M-F
8:00am to 5:00pm 
Drug Testing Central (Jefferson Bldg): 9370 SW Greenburg Rd, Ste 200, Portland 97223 (503) 977-3225 8:00 am-3:30 pm, M-F,
Walk-in 
GRESHAM URGENT CARE: 2850 SE Powell Valley Rd, Ste 100 (Powell and Burnside), Gresham (503) 666-5050, M-F 8am4:30pm, Walk-in 
URGENT CARE NW—FAIRVIEW: 22262 NE Glisan St, Fairview (503) 489-2024, M-F 8am-6pm, Walk-in 
MID-COLUMBIA MEDICAL CENTER LAB: 1700 EAST 19TH ST, The Dalles (541) 296-7225, M-F 8am-4:30 pm
CONCENTRA MEDICAL CENTER: 12518 NE Airport Way Ste 110, Portland (503) 256-2992, M-F 8am-5pm. 
ADVENTIST HEALTH: 18750 SE Stark St., Portland, (503) 666-6717, M-F 9 am-7:30 pm; Sat-Sun, 9am – 4 pm 
CASCADE OCCUPATIONAL MEDICINE: 3449 N Anchor St., Suite 500, Portland (503) 285-6627, M-F 8 am-5 pm, Walk-in DOT
CASCADE OCCUPATIONAL MEDICINE: 3108 NE 181st, Portland (503) 253-5692, M-F 8am-5pm, Walk-in. 
PROVIDENCE HOOD RIVER OCCUPATIONAL HEALTH: 1790 May St (541) 387-6391, M-F 8 am-5 pm 
LEGACY LAB ST HELENS GOOD SAMARITAN MEDICAL MALL: 500 N Columbia River Hwy, St Helens (503) 397-1801, M-F
8:30am-5pm Walk-in
CONCENTRA MEDICAL CENTER: 3449 N Anchor Ste 300A, Portland (503) 283-0013, M-F 7:00 am-5:00 pm 
BEAVERTON / HILLSBORO / TUALATIN/LAKE OSWEGO / TIGARD/NEWBERG
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LEGACY METROLAB/TWIN OAKS: 1815 NW 169th Pl Bldg.6, #6025, (facing 173rd) Beaverton (503) 533-2278, M-F 8 :30am-5 pm
(closed noon-12:30 for lunch), Walk-in 
TUALITY URGENT CARE: 7545 SE Tualatin Valley Hwy, Hillsboro, OR (503)681-4223, M-F 8 am-8 pm Random/Post Accidents
walk-ins only. Pre-employments by appt from 8am-5pm.
LEGACY METROLAB/TUALATIN: 7587 SW Mohawk Street, Tualatin (503) 672-4546, M-F 8 :30am-5 pm (closed noon-12:30 for
lunch)
TUALITY EIGHTH AVE MEDICAL PLAZA: 364 SE 8th Ave Ste 108, Hillsboro (503) 681-4100, By Appointment Only
CASCADE OCCUPATIONAL MEDICINE: 1200 NE 48th Ave, Ste 1000, Hillsboro (503) 726-1021, M-F 8am -5 pm, Walk-in 
CONCENTRA MEDICAL CENTER: 6405 SW Rosewood, Ste B, Lake Oswego (503) 675-7603, M-F 8am-5pm 
NEWBERG URGENT CARE: 2880 Hayes St, Newberg, OR, Ph. (503) 537-9600, M-F 9am-6:00 pm.
MILWAUKIE / CLACKAMAS / CANBY
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ONSITE DRUG TESTING: 10951 SE 21st, Milwaukie. (503) 652-2935, M-F 9am-5pm.
WILLAMETTE FALLS OCCUPATIONAL HEALTH: 9775 SE Sunnyside Rd, Ste 100, Clackamas (503) 654-0051, M-F, 8:00 am-5:00
pm. Walk-in 
PROVIDENCE IMMEDEDIATE CARE: 16180 SE Sunnyside, Ste 102, Happy Valley (503) 215-9900, M-F 5:00 pm-7:00 pm, Sat-Sun
9:00 am-5:00 pm, Walk-in
PROVIDENCE OCC HEALTH: 9290 SE Sunnybrook Ste 210, Clackamas (503) 216-7960, M-F 8am-4:30pm, Walk-In 
WILLAMETTE FALLS OCC HEALTH-CANBY PLAZA: 200 Hazel Dell Way, Canby (503) 263-9500 M-F 9am-5pm, Walk-in 
VANCOUVER / LONGVIEW/CHELHALIS/RENTON/WENATHCHEE / ORCHARDS / CLATSKANIE, OR / SEASIDE, OR
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LEGACY METROLAB-VANCOUVER WEST: 3305 Main St., Suite 111, Vancouver, WA, (360) 750-9765, M-F, 8:30am –Noon, 12:30
pm-5 pm, walk in.
ADC TEST CLINIC: 5501 NE 109th Ct, Suite E, Vancouver, WA (360) 256-0322, M-F 9am-4:30 pm, Walk-in 
URGENT MEDICAL CENTER AT SALMON CREEK: 14201 NE 20th Ave, Suite 3101, Vancouver, WA (360) 571-9799, M-F 8-am3 pm, Walk-in 
URGENT MEDICAL CENTER: 9430 NE Vancouver Mall Dr.,Vancouver, WA (360) 253-6947, M-F 8am-5pm, Sat 9am-3pm
WORKPLACE WELLNESS SERVICES: 1405 Delaware, Longview, WA, (360) 414-2324, M-F 7 am-5:30 pm, Walk-in, 
ST. JOHN’S HOSPITAL: 1614 E. Kessler Blvd, Longview, WA, (360) 414-2332, M-F 7am-5:30pm 
HEALTHWORKS NW: 3331 Washington Way, Longview, WA, (360) 578-2527, M-F 7am-6pm, Sat 9-Noon, 
HEALTHWORKS NW: 1595A Bishop, Chelhalis, WA, (360) 740-0444, M-F 8 am-6 pm 
WENATCHEE VALLEY CLINIC: 820 N Chelan Ave, Wenatchee, WA (509) 663-8711, M-F 8 am- 5 pm 
CLATSKANIE FAMILY CLINIC: 401 SW Bel Air, Clatskanie, OR (503) 728-0424, M-F 9 am-\11 am, 1 pm-4:00 pm
PROVIDENCE SEASIDE HOSPITAL: 725 S Wahanna Rd, Seaside, OR 97138, (503) 717-7620, M-F 7am-5pm
(503) 224-0048
(800) 547-4457
Fax (503) 228-0149