I, (_________________________), have received a copy, read, and understand the Drug and Alcohol Testing Program and its supporting documents. I consent to submit to the drug and alcohol testing program as required by the Drug and Alcohol Testing Program policy, its supporting documents, and the law.
I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents, or the law, I may be subject to discipline up to and including termination.
I also understand that I must inform my supervisor of any prescription medication I use. I further understand that drug and alcohol testing records about me are confidential and may be released in accordance with this policy, its supporting documents, or the law.
Signature of Employee:
Date:
Time:
Approved: 7/10/2003
Reviewed: 02/14/2008; 10/12/11
Revised: