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I hereby acknowledge that I have received, read, and understand my Company’s Controlled Substances and Alcohol Testing Policy (Policy) required by Department of Transportation (DOT) regulations. I understand that I am subject to and must adhere to the DOT regulations, and must abide by terms of the Company’s Policy as a condition of employment with Colas Inc.
In conjunction with my receiving a copy of the Policy, I further understand and acknowledge the following:
- My compliance with all terms of the Policy is a condition of my employment with Colas, Inc., and I agree to abide to all terms of the Policy.
- I may be required to submit to drug and/or alcohol tests based on Department of Transportation regulations as directed by the Company as a condition of my employment;
- I have read the Policy and fully understand the terms contained therein and the consequences for violation any term of the Policy.
- If a Post-Incident drug test is required under the Policy and I am seriously injured and unable to provide a specimen at the time of the accident, then this Acknowledgement shall be considered my authorization for Colas, Inc. or its designated representative to obtain hospital reports and other documents which would indicate whether there was any controlled substances and/or alcohol in my system.
- I authorize the collection site, laboratory and/or medical review officer (MRO) retained by Applicant Insight to perform any and all functions which these entities and/or individuals may be required to perform pursuant to the applicable Federal Department of Transportation Regulations. Such authorization shall include, but is not limited to, the release of test result information to Colas, Inc., verification of the use of prescribed medications, obtaining information from my physician, hospital, dentist, or pharmacist and the reporting of negative test results with a qualifying statement in cases wherein I may be taking a legally-prescribed controlled substance.
- The Company’s Policy on drugs and/or alcohol and understand failure to comply is grounds for disciplinary action, up to and including termination, in addition to any action required by DOT regulations; and
- Refusal to submit to a drug and/or alcohol test in accordance with the Policy is a violation of DOT regulations and the Policy, and may result in disciplinary action, including but not limited to suspension (with or without pay) or termination of employment, in addition to action required by DOT regulations.
- I hereby knowingly and voluntarily release and hold harmless Colas, Inc. and its subsidiaries and their respective officers, directors, employees and agents from any and all claims and liability whatsoever which may arise from the procedures and implementation of this Policy.
- I acknowledge that, in addition to the Policy, Colas, Inc. has provided to me materials with information concerning the effects of alcohol and controlled substances use on an individual's health, work, and personal life; signs and symptoms of an alcohol or a controlled substances problem (the driver's or a co-worker's); and available methods of intervening when an alcohol or a controlled substances problem is suspected, including confrontation, referral to any employee assistance program and or referral to management.
- I acknowledge that I am responsible for reading and familiarizing myself with the Policy and other materials and information related to the Policy provided to me by Colas, Inc.
- THE UNDERSIGNED STATES THAT HE OR SHE HAS READ THE FOREGOING ACKNOWLEDGEMENT AND UNDERSTANDS THE CONTENTS THEREOF.
- Company Name: SIMON
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