Healthcare & Wellness
Drug and Alcohol Testing Consent
Employee consent for drug and alcohol testing with acknowledgment of testing policy and procedures. Single signer (employee).
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# Drug and Alcohol Testing Consent **Date:** ___________ ## Company Information **Company Name:** ___________ ("Company") **Company Address:** ___________ ## Employee/Applicant Information **Name:** ___________ **Employee ID (if applicable):** ___________ **Position/Title:** ___________ **Department:** ___________ **Status:** ___________ ## 1. Testing Occasion This consent is provided for the following testing occasion: **Testing Type:** ___________ **Reason for Test (if reasonable suspicion or post-accident):** ___________ ## 2. Substances Tested The testing panel shall include: ___________ ## 3. Testing Method **Specimen Type:** ___________ **Testing Facility:** ___________
Fields (22)
consent date
date 路 required
company name
text 路 required
company address
textarea 路 required
employee name
text 路 required
employee id
text
position
text 路 required
department
text
employee status
select 路 required
testing type
select 路 required
test reason
textarea
testing panel
select 路 required
specimen type
select 路 required
testing facility
text 路 required
employee name repeat
text 路 required
policy reviewed
select 路 required
positive consequence
select 路 required
confirmatory cost
select 路 required
medications
textarea
eap
select 路 required
dot regulated
select 路 required
governing state
select 路 required
employee signer name
text 路 required
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