403.7E2 - Drug and Alcohol Testing Program Acknowledgement Form

I, ____________________, have received a copy, read and understand the Drug and Alcohol Testing Program policy 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)