Employee Agreement to Consent to Drug and/or Alcohol Testing
I, hereby consent, upon a request made under the drug/alcohol testing policy of my employed Facility, 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 the Facility’s 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 Facility and/or its physician send the specimen(s) collected to a laboratory for a screening test for the presence of any prohibited substances under the above policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Facility.
I understand that only duly-authorized Facility officers will have access to information furnished or obtained in connection with the test, that they will maintain and protect the confidentiality of such information to the greatest extent possible, and that they will share such information only to the extent necessary to make employment decision and to respond to inquiries or notices from government entities.
I will not seek legal action or hold accountable the Facility, physician, or testing laboratory the Facility might use, for any alleged harm to me that might result from such testing, including termination from employment or any other kind of adverse job action that might arise as a result of the drug/alcohol test. I will not seek legal action even if an employee at the facility or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.
I have read and understand the above policy as well as this authorization form. I have been told that if I have any questions the test or the policy, they will be answered.