DRUG SCREENING CONSENT FORM
Crystal Tones is an alcohol and drug free work environment. Employees may not be under the influence of alcohol or drugs while in the employ of Crystal Tones and working for Crystal Tones on its premises or any other premise so designated as a work place of Crystal Tones. It shall be presumptive proof “under the influence” if any employee tests, positive for Alcohol, Amphetamines, Barbiturates, Opiates, Phencyclidine, Benzodiazepine, Methadone, Propoxyphene, Urine Ethanol, Oxycodone, and Meperidine regardless of the amount of such substance. Crystal Tones shall conduct alcohol and drug testing on a randomly selected basis except that Crystal Tones shall reserve the right to individual testing should the use of alcohol or drugs be suspected.
I have read and understand the substance abuse and drug testing policy of Crystal Tones and hereby agree to comply with them, the procedure involved, and do hereby freely and voluntarily give my consent to the testing laboratory designated by Crystal Tones to perform analytical tests deemed necessary to determine the absence or the presence of alcohol and drugs in my system. I understand that if the sample I provide, urine, blood or hair, does test positive, I will be subject to denial of employment or termination of employment, to the extent permitted by applicable law.
I understand that Crystal Tones may request proof that I am taking a controlled substance as directed pursuant to a lawful prescription issued in my name. If requested, I must provide such proof within Two (2) days.
I understand that the testing to be performed will include, but may not be limited to the following: Alcohol, Amphetamines, Barbiturates, Opiates, Phencyclidine, Benzodiazepines, Methadone, Propoxyphene, Urine Ethanol, Oxycodone, Marijuana, and Meperidine and such results will promptly be submitted to Crystal Tones.
To avoid false positive results, I am advised to avoid foods with poppy seeds within 72 hours prior to testing. I am advised to refrain from drinking more than 40 ounces of liquid within 3 hours prior to providing the urine sample for testing. I understand the recommendations listed above, and I am aware that a sample reported as “diluted,” constitutes a positive result. A positive result will be confirmed as follows (or as otherwise required by applicable law):
- A positive finding of drugs by preliminary screening procedures will be subsequently confirmed by chromatography-mass, spectrometry or other scientific testing technique which has been or may be approved by the appropriate state or other governmental office.
- Furthermore, I understand that in the event a sample is reported as “diluted,” I may re-test within Two (2) days, at my own cost. If the resulting sample tests negative, I understand that Crystal Tones will reimburse me for the cost of the test.
I realize that the results of this testing will be shared to the extent required or permitted by applicable law, which disclosure may include, but is not limited to, me, and such officers, agents or employees of Crystal Tones who need to know the information for reasons connected with their employment.
My signature below signifies my consent to provide urine, blood or hair samples for testing to determine the presence of drugs in my body, as well as my consent to have the results of such test disclosed as described above, and my release of Crystal Tones, its directors, officers, employees, agents, successors and assigns, and my agreement to hold each of them harmless from, any and all liabilities, claims, losses, costs and expenses whatsoever (including attorney’s fees and court costs) arising out of or resulting from any such testing or disclosure.