CCP 12-11-1995 - Laserfiche WebLink

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. I I. . NOTICE OF DRUG OR ALCOHOL TEST RESULTS I EMPLOYEE NAME: -- I DATE RESULTS RECEIVED FROM TESTING COMPANY: CHECK AS APPROPRIATE: I The result of your alcohoVdrug test was negative. I _ The result of your alcohoVdrug test was positive. RIGHTS OF EMPLOYEE OR JOB APPLICANT IF CONFIRMATORY TEST IS POSITIVE I 1. The employee or job applicant has the right to request and receive from the employer a copy of the test result report. I 2. Within three working days after notice of a positive test result, the employee or job I applicant may submit information to the employer, in addition to any submitted prior to a test, to explain the test result. .e 3. Within five days after notice of a positive test, the employee or job applicant may request a confirmatory retest of the original sample at the employee's or job applicant's expense. Within three days after receiving the employee's or job applicant's re-test request, the I employer shall notify the testing agency of the employee's or job applicant's request. The employee or job applicant may request a different testing agency licensed under Chapter 181 (Minnesota State Statute). If the confIrmatory retest does not confirm the I original positive test result, no adverse personnel action based on the original confIrmatory test may be taken against the employee or job applicant. I I have received a copy of this completed document. SIGNED: . DATED: I I "~. I .- I ---------- ----