Employers participating in DFSP must submit an annual report to document compliance with all program requirements. The DFSP-3 is for employers participating at the basic or advanced levels. The report is due the last business day in September for the January program year and the last business day in March for the July program year.
While you're submitting the form online, you must fax all required attachments. For assistance with completing the form, download an example.
If you request to participate at the Basic or Advanced level for the next program period and you've not submitted a safety self-assessment within the last 12 months, you'll be directed to complete the Safety Management Self-Assessment (SH-26) before proceeding with this form.
You must answer all Yes/No questions. If you answer no, you must explain your answer. Once you submit the online form, you'll receive a confirmation page to print for your records. That page also will have a link to a fax cover sheet, which includes a checklist of required documents that prove compliance and a list of BWC service office fax numbers for you to submit your additional documentation.
- Policy number, Federal tax ID or Social Security number
- Contact name and phone number
- May Drug-Free correspondence be sent to the e-mail address that you provide?
- Level for next program year
- Number of employees, new hires
- How accident-analysis training was done (if not through BWC Learning Center, need sign-in sheet)
- Update on safety action plan - Advanced only
- Written DFSP policy
- Employee education - Name of qualified substance professional(s) used, credentials and dates of service
- Supervisor training - Name of qualified substance professional(s) used, credentials and dates of service
- Range of substance testing - number of tests, number of positives by type of test, specific drug, and by gender and age range
- Name of collection site, contact name/phone number, medical review officer, name of SAMHSA-certified lab
- Name of consortium if one used for random testing, contact person, phone number
- Employee assistance resources
- Number of employees terminated for positive tests and those given a second chance
- Number who failed a substance test after being given a second chance
- Number who passed a substance test after being given a second chance
- Number terminated for positive test and reasons terminated - Advanced only
- Who provides assessment services - Advanced only