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Reasonable Suspicion Consent Form

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EXPERTISE | EXPERIENCE | INTEGRITY

Drug Testing: Reasonable Suspicion Consent Form

 

(Check one)
  • I hereby consent to allow ______________________________________________________________________ (facility name) to take a specimen of my hair, urine, or blood and submit it to a laboratory testing service for a reasonable suspicion drug test. I further consent to allow the laboratory testing service to make the results of the drug test available to S.C. Swiderski, LLC.

 

  • I hereby refuse to submit for a reasonable suspicion drug test.

 

I understand that positive test results, refusal to be tested, attempts at delay of testing, or any attempt to affect the test results or test sample will result in termination of employment from S.C. Swiderski, LLC, depending on when the results are received.

I agree to hold harmless and release from all claims S.C. Swiderski, LLC and its agents (including the above-named facility) from any liability arising in whole or part out of the collection of specimens, testing, and the appropriate use of the information from such testing.

 

____________________________________________________________________________________________
                                             Employee Name (Printed)

 

_____________________________________________________________________________________________              _____________________________________
                                                     Signature                                                                                                               Date

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