• Type of Test

  • Type of testing equipment used

  • Select date

  • Screening Test Number

Employee Details

  • Employee Name

  • Should the Employee refuse to take this test, the company will take this as a positive test, and disciplinary action will take place, which may include dismissal. Should the Employee decide to take the test after this has been explained and it is a negative test they will resume normal duties after the testing procedure.

  • Screening conducted in neutral location

  • Has employee selected a witness? If yes who?

  • The actual screening mouth swab used on the employee is called a primary sample

  • Each employee is asked a series of six questions prior to their individual screening.

  • 1. Have you consumed any Alcohol in the previous 8 hours?

  • If yes more info required.

  • What type of drug?

  • At what time

  • What was the quantity consumed?

  • Are these prescribed drugs?

  • 2. Have you taken any illicit (illegal) drugs in the previous 12 hours?

  • If yes more info required.

  • What type of drug?

  • At what time

  • What was the quantity consumed?

  • Are these prescribed drugs?

  • 3. Are you currently under the effect of any illicit drugs?

  • If yes more info required.

  • What type of drug?

  • At what time

  • What was the quantity consumed?

  • Are these prescribed drugs?

  • 4. Are you taking any pharmaceutical drugs?

  • If yes more info required.

  • What type of drug?

  • At what time

  • What was the quantity consumed?

  • Are these prescribed drugs?

  • 5. Are you presently on any medication?

  • If yes more info required.

  • What type of drug?

  • At what time

  • What was the quantity consumed?

  • Are these prescribed drugs?

  • 6. Have you taken anything orally in the previous 10 minutes?

  • If yes more info required.

  • What type of drug?

  • At what time

  • What was the quantity consumed?

  • Are these prescribed drugs?

Test Results

  • Test Result

  • If positive any comment from employee yes or n/a.

  • Comment

  • Employee

  • Company Representative

  • If positive what was the course of action

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