SOP 104.59-att-2: Alcohol and_or Drug Test Notification

SOP 104.59
Attachment 2

10/30/17

MEMORANDUM

TO: Employee Name and SSN

FROM: Appointing Authority Name/Title

SUBJECT: ALCOHOL and/or DRUG TEST NOTIFICATION (RANDOM)

DATE: Date Being Issued

Your position has been randomly selected for drug testing. You will:

1. Report to the designated testing location
2. Bring a picture ID
3. Receive The Custody and Control Form; and
4. A copy will be provided to you

You are advised that if:

a) you expressly decline to submit to alcohol or other drug testing;
b) you fail to appear at the testing location by the specified time;
c) you engage in conduct that clearly obstructs the testing process;
d) you fail to provide adequate urine for testing (45ml.) and/or breath for alcohol testing

without an acceptable medical reason;
e) you leave the testing site before providing an adequate sample in the allotted time (up to 3

hours if necessary);
f) the temperature of your specimen is outside the acceptable range;
g) the laboratory and/or the MRO determine that your sample has been adulterated or

substituted, or,
h) the testing indicates use of an illegal drug(s) without a legitimate medical explanation.

This will be considered a Refusal and the actions described below will be taken:

You will be dismissed from employment and disqualified from state employment for a
period of 2 years from the date of notification.

I certify that I have read and understand the information contained in this document.

~~Applicant Signature~~ ~~Date/Time~~

Retention Schedule: Upon completion this form shall be retained permanently in the employee’s official and local
personnel file. If not hired, retain in the Interview/Selection file for two (2) calendar years