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Run: Cruise Ship MLC Drug and Alcohol Testing Consent Form

A cruise ship MLC drug and alcohol testing consent form for crew members to acknowledge testing rules, authorize specific test types, and record consent or r...

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Program Notice

Testing Program Notice

What happens after I submit?

I have read and understand the testing program notice above. (required)

Yes No N/A

Crew Member Information

Full Name (required)

Crew / Employee ID (required)

Job Title / Rank (required)

Vessel Name (required)

Department

Testing Authorization

Reason for Testing (required)

Testing Types Authorized (required)

Additional Details for Reasonable Suspicion or Post-Incident Testing

Use this field only if the testing basis requires a brief explanation for the record.

Consent, Disclosure, and Refusal

Consent Statement

I understand that my personal information will be used only for testing administration, compliance, and audit trail purposes. (required)

Yes No N/A

I understand that refusal to consent may result in removal from testing eligibility, delay in assignment, or other action permitted by law and policy. (required)

Yes No N/A

Signature (required)

Date (required)

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