Email: claims@stratfocusllc.com
Email the completed forms to claims@stratfocusllc.com or Fax to: 1 214 833 7257
ACKNOWLEDGEMENT OF REFUSAL TO SUBMIT TO
POST-ACCIDENT DRUG TEST
I_______, acknowledge that I have refused to submit to a post-accident drug
test as required by my employer. I understand that refusing to submit to a post-
accident drug test may lead to disciplinary action up to and including termination and
may result in a loss of workers' compensation and/or unemployment compensation
benefits.