I understand that the company policy at S.U.R. Construction, Inc. requires that all employees and prospective employees must submit to a controlled substances test in the application process, on a biennial or periodic basis, for reasonable/fitness for duty evaluation (may include a blood alcohol test), post-accident testing and on a random basis. I also understand that the Federal Motor Carrier Safety Regulations also mandate that drivers submit to such testing.

A urine sample will be collected and tested for controlled substances. In the case of reasonable cause/fitness for duty evaluation and post-accident, a blood alcohol test may also be performed.

I understand that if I test and am confirmed positive for use of controlled substances, I will not be considered for employment or, if already employed, will be subject to appropriate sanctions, up to and including dismissal from S.U.R. Construction, Inc.

The results of the drug test will be maintained by a Medical Review Officer who will report whether the test results were negative or positive to S.U.R. Construction, Inc. The results will not be released to any additional parties without my written authorization or as otherwise authorized by law. Instances when results can be released include the following:

1-The Medical Review Officer can transmit to appropriate parties (e.g., the employer, a certifying physician, a DOT agency) information concerning medications being used by the employee or the employee’s medical condition only if, in the Medical Review Officer’s medical judgment, the information indicated that the employee may be medically unqualified under applicable DOT agency rules or would otherwise present a safety hazard.

2-Information can also be transmitted to third parties in accordance with Department of Transportation agency regulations (e.g., a DOT agency regulation calling for the provision of information to the National Transportation Safety Board in an accident investigation).

3-And, information about drug tests may also be released when an employee challenges action taken by an employer as a result of a drug test.

I hereby agree to submit to a drug screen urinalysis. In the case of reasonable cause/ fitness for duty evaluation or post-accident, I also agree to a blood alcohol (BAC) test.