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PRE-EMPLOYMENT/NEW EMPLOYEE CONSENT AND AUTHORIZATION FOR SUBSTANCE <br />TEST COLLECTION AND ANALYSIS <br />Reynolds Construction has a policy prohibiting the possession, distribution, use, consumption or being under the <br />influence of alcohol or illegal and unauthorized drugs, including synthetics and designer types and other harmful <br />substances while at work, in order to provide a safe and healthful environment for our employees, customers, <br />suppliers, visitors, and members of the general public. <br />I HAVE READ THE REYNOLDS CONSTRUCTION COMPANY SAFETY POLICY FOR DRUGS AND ALCOHOL, <br />WHICH I UNDERSTAND AND AGREE TO ABIDE BY AS A CONDITION OF EMPLOYMENT. I FURTHER <br />UNDERSTAND THAT THIS POLICY IS NOT A CONTRACT BETWEEN REYNOLDS CONSTRUCTION AND <br />MYSELF. I UNDERSTAND, HOWEVER, THAT EMPLOYMENT WITH REYNOLDS CONSTRUCTION IS <br />CONDITIONAL UPON SATISFACTORILY PASSING THE REQUIRED DRUG AND ALCOHOL SCREENING TEST. <br />All employees of REYNOLDS CONSTRUCTION who test Positive for Drug/Alcohol tests which include Pre- <br />Employment, Probable Cause, Random, and Post Incident will pay for the tests, including (G.C.M.S.) <br />Confirmation Tests. All Employees who request split specimens to be forwarded to another lab shall pay for <br />the cost. Cost of the tests shall be withheld from employee's paycheck effective next paycheck. REYNOLDS <br />CONSTRUCTION will pay for all Negative Drug/Alcohol Tests. <br />I hereby consent to Reynolds Construction to have collected from me urine and to conduct other necessary medical <br />tests to determine the presence of drugs or controlled substances and alcohol. I give my consent for the release of <br />these tests results and other relevant medical information to the authorized company designee for appropriate review. <br />I understand that if I refuse consent I may be subject to disciplinary action, including termination of employment. This <br />test is required for the company substance abuse policy as well as for the federal code of regulations for various DOT <br />drivers. <br />Federal regulations require this consent form to be signed so that information on drug and alcohol test results for the <br />previous two years can be obtained from prior employer. The previous employer’s shall furnish reports of any positive <br />drug tests, any BAT results of 0.04 or greater or refusal to either test. <br />I hereby agree to submit to the various tests as required for either specific reasons or just generally for our 50% drug <br />test and 10% alcohol test standards as presented by the federal government. <br /> Pre-Employment ______________ Random _____________ <br /> Periodic ______________ Follow-up_____________ <br /> Reasonable Cause ______________ Post Incident/Injury _____________ <br /> <br />Agreed to: ___________________________ Date/Time: ____________________ <br /> <br />Witness to: ___________________________ Date/Time: ____________________ <br /> <br />Refused: ___________________________ Date/Time: ____________________ <br /> <br />Witness to: ___________________________ Date/Time: ____________________ <br /> <br />Reason for Refusal: ______________________________________________________ <br /> <br />WRITTEN SAFTEY PROGRAM Page | 249 <br /> <br />