Drug test information

• Prepared by

• Client

• Project

• Location
  Address

Drug test

• Employee details

• Picture of operative.

  Media

• Test type. Date & Time

  Date

Information

• Aware of Drugs and Alcohol policy

• Not on medication

• No alcohol in previous hours.

• No recreational drugs in previous weeks

• No cough sweeties

• No diabetes or illness likely to effect readings.

• Other:

• Other description:

Explain test procedure ( check all that apply )

• Explained type of test

• Explained test readings and demonstrate non negative results.

• Explained possible outcomes.

Test results

• Test results

  negative result

  trace elements

  NON negative result

  Other

• Other description:

Statement (Check Proper Box)

• I agree with the explanations identified in this report

• I disagree with the explanations identified in this report because:

• Signature

  Sign

• Safety or management Signature

  Sign