Policy Statements > Alcohol and Drug Policy

Acohol and Drug Testing Employee Consent Form

I _____________________________________, authorize:

Southeast Health Group

1209 – 5th Street

Estevan, SK.

306-634-6630

to obtain a breath, saliva, or urine samples to determine alcohol and drug content.

I understand that the results will be used in evaluating my physical condition and I authorize the release of these findings to a medical review officer and/or the designated employer representative.

I have been given access to and understand the Power Tech Industries alcohol and drug policy and procedures.

I understand and agree to comply with the conditions set out in the policy and procedures.

I have taken the following medications (prescription and over the counter) in the past two week period:

______________________________

Employee Name:

______________________________ ____________________

Employee Signature: Date:

______________________________ ____________________

Witness Signature: Date:

Drug Testing Consent Form

Drug Testing Consent Form