EMPLOYEE NOTICE AND
ACKNOWLEDGEMENT FOR TESTING
AFTER REHABILITATION
PART 1: NOTICE
The company/organization is pleased to learn that you are returning to
duty after successfully completing an approved program of drug and/or alcohol
rehabilitation.
In accordance with the company's/organization's drug-and alcohol-free
workplace program, you will be subject to a reasonable program of follow-up drug
and/or alcohol testing without prior notice for not more than 60 months after
return to duty.
This program of follow-up testing will be in addition to the other
testing requirements imposed on all employees, such as reasonable cause testing,
post-accident testing and random testing.
PART II: ACKNOWLEDGEMENT
I acknowledge receipt, understanding and acceptance of the above
written notice.
_________________________________________________________________
(Signature) (Date signed)
_________________________________________________________________
(Printed name) (Signature of witness)
Note: This form should be customized with your company or
organization's name and should reference only drugs or alcohol, or both,
depending upon which options you select for testing requirements.
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