I have reviewed the Employee Safety Program including the training for Bloodborne Pathogens, Safety Data Sheets, Personal Protective Equipment and Hazardous Communication. I agree to follow all procedures therein. I understand that it is my responsibility to utilize safe practices while at work to protect myself and others. I understand that I must report to management any incidents before my shift ends and seek immediate treatment. If I do not report to management at the end of my shift, I understand that I cannot seek treatment afterwards. Deviation from the Safety Program will result in disciplinary action up to and including termination.

· I agree to submit to testing for the detection of drugs and/or alcohol at the time of initial treatment. I give permission for test results to be released to ParCou LLC.