Common use of DRUG AND ALCOHOL SCREEN EXAM CONSENT FORM Clause in Contracts

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.

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.

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.