ALCOHOL AND DRUGS TESTING CONSENT FORM

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I...

Name*

hereby consent to the following tests for the detection of alcohol and drugs:
• Oral fluid test for Alcohol, Amphetamine, Methamphetamine, Benzodiazepines, Phencyclidine, Cannabis, Cocaine, Opiates, Methadone, Oxycodone, Cotinine, Synthetic Marijuana, Ketamine, Barbiturates, Buprenorphine, Tramadol, 6-mono-aceto-morphine, Fentanyl.

James Lynch Transport Ltd (the Company) has informed me about its drug and alcohol policy and I understand that refusal to consent to the test will be considered as failure to comply with Company policy and will result in disciplinary action. I also understand that if the test is positive for any of the above substances, I will have an opportunity to explain the positive result to the Managing Director. If I am unable to offer a satisfactory explanation for the positive result, I understand that the matter will be dealt with in accordance with the Company’s Disciplinary Procedure. I consent to the retention of test results to the Company. I understand that the results will be kept confidential and will not be disclosed to any person other than myself, the Transport Manager, the Traffic Office Manager and Directors of the Company where necessary for employment purposes. This information may also be shared with third party legal advisors. You have the right to withhold consent to undergo the initial oral fluid drug and alcohol testing. You also have the right to withdraw consent at any time following the test. Please refer to the Drug and Alcohol Policy in the Employee Handbook.

EMPLOYEE NAME*

FIRST NAME LAST NAME

EMPLOYEE SIGNATURE*

DATE*

TESTERS NAME*

FIRST NAME LAST NAME

TESTERS SIGNATURE*

DATE*

Result*

Pass

Fail

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