Drug & Alcohol Testing Notification & Consent - State Rail ...
WEST VIRGINIA DEPARTMENT OF TRANSPORTATION
STATE RAIL AUTHORITY
DRUG/ALCOHOL TESTING NOTIFICATION & CONSENT
I understand, as required by Title 49, Code of Federal Regulations, Parts 40 and 212, and by the policy of the West Virginia Department of Transportation, State Rail Authority, any prospective employee (or a present employee entering into a covered position) who is to perform a safety-sensitive function:
• Must submit to a controlled substance test involving collection of a urine sample which will be tested for the presence of:
Marijuana/Tetrahydrocannabinol (THC)
Cocaine
Opioids
Amphetamines
Phencyclidine (PCP);
AND
• Must submit to a breath alcohol test consisting of a deep lung breath sample that is to be provided to, and analyzed by, and Evidential Breath Testing Device (EBT).
I understand, if I test positive for drugs or have a breath alcohol concentration of 0.02 or greater, that I am considered medically unqualified to perform a safety-sensitive function. Transferring/Promoting employees are hereby referred to the West Virginia Department of Transportation/Division of Highways Drug and Alcohol Testing policy for further information. I also understand that I will be given reasonable opportunity to confer with the Agency’s Medical Review Officer before any positive drug test result is reported to the Human Resources Division/Office of the Director of Operations and Training.
It is understood a positive drug test result and/or a breath alcohol concentration of 0.02 or greater will disqualify me for employment/transfer/promotion with the West Virginia State Rail Authority and my test results will not be released to any additional parties without my written consent.
I hereby agree to submit to a urine drug test as a precondition of employment/transfer/promotion. After employment/transfer/promotion, I hereby agree to submit to random urine drug testing and breath alcohol testing and other regulations as required by Title 49 CFR Parts 40 and 219 and the West Virginia Department of Transportation’s Drug and Alcohol Testing Policy.
Applicant’s Name (Print): Soc Sec #
Applicant’s Signature: Date:
PE – 2B Rev. 11/2019
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- drug alcohol testing notification consent state rail
- the purpose of the drug education evaluation treatment
- random testing roster additions and deletions
- fta suggested collection site drug test correction
- guidance q a federal motor carrier safety administration
- faa drug abatement division s suggested notification to
Related searches
- blood alcohol testing procedures
- blood alcohol testing results
- alcohol testing form
- home urine alcohol testing kits
- etg alcohol testing calculator
- drug patch testing false positive
- drug and alcohol testing program
- drug and alcohol testing laws
- drug and alcohol testing center
- drug alcohol counseling certification
- blood alcohol testing machines
- dot breath alcohol testing guidelines