Driver'S Receipt Template (J. J. Keller'S Alcohol & Drug Testing)
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1DRIVER’S RECEIPT
I acknowledge receipt of J. J. Keller’s Alcohol & Drug Testing: Driver
Awareness Training Driver Handbook containing the following topics:
•
Introduction
•
Abbreviations
•
Definitions
•
Who is Covered by the Alcohol and Drug Regulations?
•
What is a Safety-sensitive Function?
•
What are the Alcohol and Drug Prohibitions?
•
What Tests are Required and When Will I Be Tested?
✓
Pre-employment
✓
Post-accident
✓
Random
✓
Reasonable Suspicion
✓
Return-to-duty and Follow-up
•
What Happens if I Refuse to Be Tested?
•
How is Drug and Alcohol Testing Performed?
•
What are the Consequences of Violating the Drug and Alcohol
Prohibitions?
•
Where Can I Go for Help?
✓
Self-admission of Alcohol and Drug Use
•
What are the Effects of Drugs and Alcohol on the Body?
______________________________________ __________
Driver’s Signature
Date
__________________________________________________
Company
______________________________________ __________
Facilitator’s Signature
Date
__________________________________________________
Company
NOTE: This receipt shall be read and signed by the driver. A responsi-
ble company supervisor shall countersign the receipt and place it in the
driver’s training file.
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