• REFUSAL OF POST-ACCIDENT DRUG TEST

  • Strategic Focus Clear Vision Defined Strategy. Proven Results.

    3540 E. Broad St. Store 6870 #126 Mansfield, Tx 76063

  • 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.

  • Clear
  •  /  /
    Pick a Date
  • Clear
  •  /  /
    Pick a Date
  •  
  • Should be Empty: