Fill and Sign the Challenge of Drug Screen Form

Challenge of Drug Screen Standard Policy We have received a positive, confirmatory result for your drug screen test. You tested positive for __________________ . You may have already received a notice of the positive drug screen test from the medical review officer of the laboratory that conducted the test. You may request a confirmatory retest of the original urine sample at your expense. You have five working days after notice of this positive test result to notify us in writing that you want to obtain a confirmatory retest. Within three days after receiving any such notice from you, we will notify the original testing laboratory that you have requested it to conduct a confirmatory retest. The confirmatory retest will use the same drug or alcohol threshold detection levels as used in the original confirmatory test. If the confirmatory retest does not confirm the original positive test result, no adverse personnel action based on the original confirmatory test will be taken. You may consult with the medical review officer for technical information regarding prescription or nonprescription medication. The telephone number for contacting the medical review officer is ___________________ . In addition to requesting a confirmatory retest, you may submit information to explain the results or explain why the results do not violate company policy. You have five working days after this notice to do so. You are to submit this additional information to the medical review officer of the laboratory which conducted the test. That address is ______________________ . This opportunity to submit information is in addition to any opportunity already provided by the laboratory and you may submit the same or additional information. You have the right to request and receive a copy of the test result report. If you do not provide additional information, if the additional information is not a satisfactory explanation, if you do not request a confirmatory retest, or if the confirmatory retest confirms the original positive test, then: (A) If you are an applicant, the conditional job offer will be withdrawn and your application will no longer be considered; (B) If you are an employee, you may be disciplined, which discipline may include discharge. If your explanation or challenge of a positive drug test is unsatisfactory, a written explanation as to why it is unsatisfactory along with the report of the positive test results will be provided by the company. In some states, you may have the right to contest the test result with the state Department of Labor. If you choose to challenge the test result further, you must notify the laboratory to retain the specimen until the matter is resolved.