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Drug And Alcohol Test Consent Form

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CLIENT COMPANY

____________________

Drug and Alcohol Test Consent Form

CONSENT FOR PRE-EMPLOYMENT, RANDOM, OR REASONABLE SUSPICION DRUG AND ALCOHOL TEST SCREEN AND RELEASE

COVENANT NOT TO SUE AND INDEMNITY AGREEMENT

I hereby CONSENT to allow [Medical Facility] to take a specimen of my hair, urine, or blood and submit it for a pre-employment,

random, or reasonable suspicion drug test screen. I FURTHER CONSENT to allow the laboratory testing service to make the results of

such screen available to the prospective or current employer [Company].

In consideration for such services being rendered on my behalf, I hereby RELEASE the laboratory testing service, its officers, agents,

and employees, from any and all claims which I might otherwise have due to such results being made so available. I hereby

CONSENT NOT TO FILE ANY ACTION at law or in equity against [Company], the laboratory testing service, their respective officers,

agents or employees in connection with the results of such screen being made so available, and I hereby agree to INDEMNIFY and

SAVE HARMLESS [Company], the laboratory testing service, their respective officers, agents, and employees from all damages,

expenses, reasonable attorney's fees, and costs of court which they or any of them may suffer or incur, jointly or severally, due to

the results of such screen being made so available.

_____________________________________

(SIGNATURE)

_____________________________________

(NAME PRINTED)

_____________________________________

(DATE)

CURRENT MEDICATIONS (PRESCRIPTIONS & NON-PRESCRIPTION)

___________________________________________________________________

HR Form 006 - Drug and Alcohol Test Consent - 9/24/14

Drug And Alcohol Test Consent Form

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