Part 8/11: Drug and Alcohol Testing Consent Form
I hereby agree, upon a request made under the drug/alcohol testing policy of REGULUX TRANSPORT LTD, to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or swab for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under SLA agreement, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorise and give full permission to have the Company Alere Toxicology send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the REGULUX TRANSPORT LTD and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorise REGULUX TRANSPORT LTD to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test.
I understand that only duly-authorised Company officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make SLA decisions and to respond to inquiries or notices from government entities.
I will hold harmless REGULUX TRANSPORT LTD, its company contracted business partners, and any testing laboratory & collection officer the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of work or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if a REGULUX TRANSPORT LTD or laboratory representative makes an error in theadministration or analysis of the test or the reporting of the results. I will further hold harmless REGULUX TRANSPORT LTD, its Sample collection officer, and any testing laboratory that REGULUX TRANSPORT LTD might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.
This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered.
I UNDERSTAND THAT THE REGULUX TRANSPORT LTD WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT. ALSO, I UNDERSTAND THAT I WILL BE SUBJECT TO RANDOM DRUG SCREEN AND/OR ALCHOL TEST UNDER THIS POLICY AND I AGREE TO SUBMIT TO ANY SUCH TEST.
Data ProtectionWithin the terms of the UK Data Protection Act (DPA) we are required to inform you of the information that we collect about you. Some of the information is regarded as sensitive data as defined in the DPA.
The test result, any medical information you have disclosed and the reason for the test are of sensitive nature. The fact that you have been tested is not regarded as sensitive information.
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Document Name: Part 8/11: Drug and Alcohol Testing Consent Form
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