Individuals cannot, however, be forced to take drug tests against their will. I hereby acknowledge that i have been advised of the citadel s policy on hallucinogenic, narcotic, and other controlled drugs and substances and drug paraphernalia and drug testing policy. This form may be used to satisfy the requirements for periodic testing requirements in accordance with title 46 cfr 16. Photocopy template for iscreen ofd employee drug testing.
The form was created by the manufacturer in order to provide drug testing program administrators with an easy method for record keeping. A drug testing consent form is used by companies and organizations to conduct mandatory drug and alcohol tests for their employees and staff. Results are transmitted electronically to the labcorp system. I certify that the donors identification had been positively verified and that the specimen identified on this form is the specimen that the donor provided. By the attached sample form, the applicant consents to undergo a drug test and authorizes the testing facility to release the results to the employer. Use this form when testing employees not regulated by dot. Print donors name first, mi, last date modayyr date modayyr x signature of donor step 2. To be completed by screening personnel drug name device code negative confirm not tested cocaine coc marijuana thc opiatesmorphine opimor amphetamine amp methamphetamine mamp phencyclidine pcp benzodiazepine bzo barbiturates bar methadone mtd tricyclic. Afterwards the results of the test will be made known to the patient and, if positive, the employee or individual whos been tested may face. Photocopy template for iscreen ofd employee drug testing kits. Employee must sign a consent form prior to the release of results. Download drug test results form templates in pdf for free. Enter the type of drug test panel for example a 5 panel drug test. The well being administration is happy to announce a new process for obtaining the results of drug testing that will make it easier to request and receive the results in a timely fashion.
Drug test result form fill out and sign printable pdf. Test results record drug test kits, drug screening. Iii harmful risk of health problems related to drug use and a possible mild or moderate substance use disorder brief intervention or. Sample drug testing policy society for human resource. The way to complete the online drug test results templates on the internet. Oct 11, 2012 drug and alcohol testing resources for key persons. Release of information form 49 cfr part 40 drug and alcohol testing. Drug testing faqs tests, detection times, and false.
Helps you comply with alcohol and drug testing procedure requirements. This form may also be justified by reasonable suspicion of drug or alcohol abuse. To be completed by screening personnel drug name device code negative confirm not tested. Std test results pdf fill out and sign printable pdf. Parties shall sign all necessary releases to effectuate release of the above testingassessment results to the appropriate people and entities. Drug testing 2part result form photocopy template information. Within the form, the employee gives the employer permission to test their urine, hair, blood.
Release of information form 49 cfr part 40 drug and. This is a pdf version of our urine drug test 2part result form and can be used in lieu our paper forms. Lab test results are released to your ordering physician before you can view them online. Test results may be used in arbitration, administrative hearings and. Urine initial drug screen result form daytime phone. Most companies will demand this test or screening before they hire a job candidate for the position that he is applying for. Retain a copy of this form and the federal drug testing, custody and control form andorthe m ros report of positive controlled substance result in the motor carrier records as required by 49 cfr, parts 40 and 382 or other parts applicable to cdl holders. You must take and pass your drug test no more than ninety 90 days before the interim date. Similarly, a drug test on a newborn at birth does not determine whether the mothers use or the extent of the mothers use has. For this, a random drugalcohol testing consent and information release form must be obtained from the subject.
Initial test results completed by collectortester negative further testing neededall nonnegative results must be confirmed using gcms. Labcorp patient tm portal allows you to view, download and print your labcorp test results, and provides tools to pay your bill online and schedule appointments. Drug testing is not meant to be punitive, but is a tool to help parents stay drug free. I understand that, should my testing results be confirmed positive or i refuse to test, i will be subject to the companys disciplinary action, including possible discharge. The photocopy template for icup drug testing kits found at. Enter your official contact and identification details. To be completed by screening personnel drug name device code negative confirm not tested cocaine coc marijuana thc opiatesmorphine opimor amphetamine amp methamphetamine mamp phencyclidine pcp benzodiazepine bzo barbiturates bar. The types of drug tests include, but are not limited to, saliva drug test oral fluid based drug test, hair follicle, and urine. The test administrator signs the form as evidence the test was completed in accordance to the instructions. Overview drug use can have a serious disruptive effect on a working or academic environment. Gas chromatography mass spectrometry gcms testing is available for confirmation of presumptive positive specimens. This electronic form allows the user to fill out the form using a computer and print as many copies that are needed.
The donor completes their information then signs and dates the form. The vendor shall also insure all tests are observed by an individual of the same gender as the client. Drug name donor results shown above alcohol screen if performed neg positive tested. Drug testing faqs tests, detection times, and false positives. After the test is complete, the test administrator marks which drugs of abuse were tested and the results of the test.
Initial test results drug alcohol testing services and. I understand that failure to pass the drug test may result in disciplinary action up to and including termination, and that i may be required to participate in a mandatory rehabilitation treatment program if offered by employer as a condition of continued employment should my drug test results indicate drug abuse. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Test results inbox similar to an email inbox, your test results inbox will contain only results that have not been viewed, meaning you have not clicked on the result label e. The drug and alcohol testing consent form is used by employers to screen applicants and employees for drug andor alcohol use. Screen results confirm results must be confirmed by laboratory. A drug testing consent form is used by companies and organizations to conduct mandatory drug and alcohol tests for all of their employees. Mother shall submit to a drug test drugalcohol assessment urine screen hair follicle analysis minimum for. Drug test results page 6 of 15 quick start guide revised. Where drug or alcohol testing is part of a routine physical or random screening, there will be no adverse employment action taken until the test results are in. Start a free trial now to save yourself time and money. What drugs the test will cover, and the expected results e. Drug test results templates fill out and sign printable.
Therefore, you may want to make a list of those medications for your own records. These documents are specially created, collected and checked to ease your paperwork. This form is also available as a pdf download from. Release of information form 49 cfr part 40 drug and alcohol testing odapc release of information form. Random drugalcohol testing consent and information release form randomized drugalcohol tests are more effective than those which are informed prior due to the limited period of time for the test subjects preparation. I certify that i provided my specimen to the collector, that the specimen container was sealed with a tamper proof seal in my presence and that the information provided on this form tests to the health care provider. Afterwards the results of the test will be made known to the patient and, if positive, the employee or individual whos been tested may face consequences if the company operates a drugfree work. Drug testing is the evaluation of urine, blood or another type of biological sample to determine if the subject has been using the drug or drugs in question. Urine drug testing centers for disease control and. A lot of companies would require applicants to take a drug test or screening test even before they hire a job candidate for the position. Photocopy template for icup employee drug testing kits author. Drug testing is not meant to be punitive, but is a tool to help parents stay drugfree. Along with other medical forms and papers, a drug test consent will indicate the willingness and the participation of an employee.
How you can fill out the urine initial drug screen result form on the internet. Consent to employee drug andor alcohol testing i understand that submission to a postinjury drug andor alcohol screen is a condition of employment with this employer. Urine initial drug screen result form drug and alcohol test. I hereby agree to submit to a urinalysis for the purpose of testing for drug metabolites. Consent for preemployment, random, reasonable susp icion drug test, or reasonable suspicion alcohol test.
Retain a copy of this form and the federal drug testing, custody and control form andor the mros report of positive controlled substance result in the motor carrier records as required by 49 cfr, parts 40 and 382 or other parts applicable to cdl holders. The job offer may be conditioned upon the test results and the applicant should be informed that the offer will be withdrawn if the results are not acceptable. Failure to take your drug test on time will result in a suspension. Test results record drug test kits, drug screening supplies. Father shall submit to a drug test drug alcohol assessment urine screen hair follicle analysis minimum for presence of marijuana, cocaine, opiates, pcp and amphetamines at. There are many circumstances that may require drug testing. The types of drug tests include, but are not limited to, saliva drug testoral fluid based drug test, hair follicle, and urine. Preemployment drug screening test or random, workrelated drug testing to. A negative drug test result only indicates that the test did not detect the drug or its metabolite or that its concentration is below the established cutoff level in that particular specimen at that time. If initial screen is positive, specimen is forwarded to laboratory for confirmation testing.
All sample collections drug tests will be observed sample collections tests. Employee drug testing ace subject the photocopy template for iscreen ofd drug screening kits found at. Fill out, securely sign, print or email your blank std test results form instantly with signnow. Agreeing to take a drug test will show an applicants willingness. Iii harmful risk of health problems related to drug use and a possible mild or. Keep all your key alcohol and controlled substance forms in one spot. In the form, the subject of the test procedure will be able to know what policies and regulations are requiring him to take the. The advanced tools of the editor will lead you through the editable pdf template. A drug alcohol testing consent form is a document which is used by organizations, institutions, and companies to obtain and record the approval of an individual who is subjected to undergo a drug and alcohol testing. Within the form, the employee gives the employer permission to test their urine, hair, blood, or any other physical sample for indicators. The test administrator assignes the test id number. The advanced tools of the editor will guide you through the editable pdf template. Within the form, the employee gives the employer permission to test their urine, hair, blood, or any other physical sample for indicators of substance abuse. Pdf version of the 2part result form for urine or saliva employment drug tests.
Testing for evidence of this use may be necessary to protect an organization from such disruptions and to protect the health and safety of all individuals in the surrounding areas. Similarly, a drug test on a newborn at birth does not determine whether the mothers use or. Our employee drug testing result forms come in both paper and pdf versions. The test will usually require the patient to supply a hair or urine sample. The drug and alcohol test consent form allows a 3rd party, usually an employer, to conduct a quick medical examination. Contact your doctor if you have questions concerning a test or your results. An employee who has verified positive drug test results on two drug tests required by 14 cfrpart 120 and conducted after september 19, 1994 is permanently precluded from performing for an employer the safetysensitive duties the employee performed prior to the second drug test.