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SOUTHLAND T RANSIT, INC.
SUBSTANCE ABUSE PREVENTION
FTA D RUG & ALCOHOL COMPLIANCE
Policy Acknowledgement and Consent to Testing
--,-,--c=---cc-.,---:--,.--,--' acknowledge that 1 have received a copy of the
Southland Transit, Inc. Substance Abuse Prevention policy, and fu lly understand
that as an employee I must consent to submit to a drug test and/or an alcohol
test when required by Federal law, or where otherwise stated in the policy. I also
authorize the release of all test results obtained during the testing procedure(s) to
the transit system and it's designated Medical Review Officer and Substance
Abuse Professional.
I understand that refusal to submit to testing or providing false information in
connection with a test may result in disciplinary action, up to and including
termination.
Employee Signature
Supervisor
Dale
Original:
Copy to:
Personnel File
Employee and
Drug & Alcohol File
(Form G)
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