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Run: Drug & Alcohol Test Consent

Drug & Alcohol Test Consent is a workplace form for documenting notice, consent or refusal, and the start of chain of custody before a regulated test. Use it...

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Test Notice

I have read and understand the testing notice (required)

You must acknowledge the notice before proceeding.

Yes No N/A

Reason for test (required)

If other, describe the reason

Test type (required)

Participant Information

Full name (required)

Employee ID or badge number

Use an internal identifier if available. Do not enter SSN.

Date of birth

Collect only if required by your testing program or chain-of-custody process.

Phone number

Consent and Authorization

Do you consent to the requested drug and/or alcohol test? (required)

Consent acknowledgment (required)

By consenting, I authorize specimen collection, testing, laboratory analysis, and release of results to authorized parties as permitted by law.

Reason for refusal

Provide a brief reason if the individual refuses the test.

Refusal acknowledgment

I understand that refusal may have employment, regulatory, or safety consequences under applicable policy and law.

Yes No N/A

Chain of Custody Initiation

Collection site (required)

Collection date (required)

Collection time (required)

Collector name (required)

Specimen type (required)

Acknowledgment and Signature

I certify that the information provided is true and complete to the best of my knowledge (required)

Yes No N/A

Signature (required)

Date signed (required)

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Email (required)

Your name (optional)

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