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HomeMy WebLinkAboutDrug Test InformationY. Consent to Release Drug Test Information 1, , whose social security number is , and whose date of birth is , do hereby authorize the (Records Custodian) to release all information and records relating to drug test performed on any specimens provide by me, including any and all records, charts, reports, notes, tests results, documents and correspondence to whose address is The above referenced information is being requested for the purpose of The duration of this consent shall be for Name: Address Telephone Number: (Theperson signing this consent must he theperson tested andprovide positiveproof of identification.) R. Employer's First Letter to Applicant or Employee - Positive Test Results Date: Dear: Pursuant to the Drug Free Workplace policy of Greater Miami Caterers' it has been determined that you have a positive confirmed drug test result. As a consequence of this positive drug test, you are being [describe actions based on your written policy] as follows: [describe the action you are taking.] Enclosed is a copy of the statement that you originally signed which explained your rights in detail. However, we would like to again reiterate your rights, duties, and obligations under the company's .drug free workplace program. 1. You have the right to contest or explain the result of the test within five (5) working days after you receive this letter notifying you of the test results. (The explanation should state why the test results do not constitute a violation of this company's drug f.Yee workplace policy.) 2. You also may have the right to appeal to the Public Employee Relations Commission or appropriate court regarding any applicable collective bargaining agreement or contract (include if applicable). If you intend to contest or explain the results of the drug test, you must notify the testing laboratory of any administrative or civil action brought and advise the laboratory of the need to retain any sample taken. The name, address and telephone number of the testing laboratory is: 3. You have the right to consult this testing laboratory for technical information regarding prescription and non-prescription medications or other relevant information. 4. You have the right to a copy of the drug test results upon request and to have a portion of any sample or specimen taken and retested, at your expense, at a laboratory of your choice. The testing must be done at an Agency for Health Care Administration (ARCA)-licensed or NIDA approved laboratory. The testing must be performed within 180 days after receipt of this letter. The second laboratory test must test at equal or greater sensitivity for the drug in question as the first laboratory. The first laboratory which performed the test shall be responsible for the transfer of the portion of the specimen to be retested, and for the integrity of the chain of custody during such transfer. If you intend to have the specimen retested, please advice so that the sample can be forwarded to the laboratory of your choice. 5. By administrative rule, this employer has 15 days to respond to your explanation of why your positive drug test is not in violation of the drug free workplace program. If your explanation is not accepted, you have the right to administratively challenge this position by filing a claim with a Judge of Compensation Claims within thirty days after receipt of this employer's response to your explanation. If you intend to challenge the drug test, it is your responsibility to notify the above stated laboratory at the address and telephone number shown to ensure that the specimen is retained. M. Employer's Second Letter to Applicant or Employee - Positive Test Results Dear We are in receipt of your explanation (and/or challenge) of the positive test results. Following the company standards and developed policies, you explanation or challenge is unacceptable and unsatisfactory because: Attached in the report of the positive test results. This is to advise you that (describe action you are taking). Reference is made to our prior correspondence to you dated and the statement you signed on This explains in detail what your various alternatives are in regard to contesting this action. All documentation relating to drug testing, including this letter, shall be deemed confidential as provided in Section 440.102, Florida Statutes.