DRUG AND ALCOHOL SCREEN EXAM CONSENT FORM Sample Clauses

DRUG AND ALCOHOL SCREEN EXAM CONSENT FORM. Employee Name Social Security No. Date of Birth / / M F Date / / Time am/pm Name of Supervisor/Agent Requesting Exam Name of Appointing Authority or Designee Authorizing Testing I consent to an examination and the collection of blood and urine specimens by and the release of the test results by laboratory as requested by the (Appointing Authority) to determine the presence of alcohol and/or drugs, if any.
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Related to DRUG AND ALCOHOL SCREEN EXAM CONSENT FORM

  • DRUG AND ALCOHOL TESTING Employees may be tested for drugs and/or alcohol pursuant to the provisions of the Employer's Drug and Alcohol Testing Policy which is attached hereto and made a part of this Agreement as if more fully set forth herein.

  • DRUG AND ALCOHOL FREE WORKPLACE 20.1 All employees must report to work in a condition fit to perform their assigned duties unimpaired by alcohol or drugs.

  • Drug and Alcohol Policy 67.1 The Parties agree to apply the Drug and Alcohol Management Program (as amended from time to time) contained in Appendix G. 67.2 The Employer may refer an Employee affected by drugs or alcohol to the services provided by Incolink.

  • Drug-Free Workplace Certification As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of Indiana, the Company hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free workplace at the Project Location. The Company will give written notice to the IEDC within ten (10) days after receiving actual notice that the Company, or an employee of the Company in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace. False certification or violation of this certification may result in sanctions including, but not limited to, suspension of payments under the Agreement, termination of the Agreement and/or debarment of contracting opportunities with the State for up to three (3) years. In addition to the provisions of the above paragraph, if the total amount set forth in the Agreement is in excess of $25,000.00, the Company agrees that it will provide a drug-free workplace by: A. Publishing and providing to all of its employees a statement notifying them that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Company’s workplace, and specifying the actions that will be taken against employees for violations of such prohibition;

  • Alcohol and Drug-Free Workplace City reserves the right to deny access to, or require Contractor to remove from, City facilities personnel of any Contractor or subcontractor who City has reasonable grounds to believe has engaged in alcohol abuse or illegal drug activity which in any way impairs City's ability to maintain safe work facilities or to protect the health and well-being of City employees and the general public. City shall have the right of final approval for the entry or re-entry of any such person previously denied access to, or removed from, City facilities. Illegal drug activity means possessing, furnishing, selling, offering, purchasing, using or being under the influence of illegal drugs or other controlled substances for which the individual lacks a valid prescription. Alcohol abuse means possessing, furnishing, selling, offering, or using alcoholic beverages, or being under the influence of alcohol.

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