Get Drug and/or Alcohol Testing Consent Form

Drug and/or Alcohol Testing Consent Form Employee Agreement and Consent to Drug and/or Alcohol Testing I hereby agree upon a request made under the drug/alcohol testing policy of the Company to submit to a drug or alcohol test and to furnish a sample of my urine breath and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy or if I otherwise fail to cooperate with the testing procedures I will be subject to immediate termination* I further authorize and give full permission to have the Company and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test. I will hold harmless the Company its company physician and any testing laboratory the Company might use meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test even if a Company or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company its company physician and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test as long as the explained in the paragraph above. This policy and authorization have been explained to me in a language I understand and I have been told that if I have any questions about the test or the policy they will be answered* I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT. Signature of Employee Date Employee s Name Printed Company Representative Note This document is for informational purposes only and may not be appropriate for your situation* Please consult an attorney for all legal matters. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy or if I otherwise fail to cooperate with the testing procedures I will be subject to immediate termination* I further authorize and give full permission to have the Company and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test. .