I understand that the Goodwill Fire Co., Inc. has a Substance Abuse Policy and is committed to making a good faith to insure a safe, secure, and drug-free workplace for its members consistent with the Drug Free Workplace Act of 1988. I also understand that Pre-Membership Drug Screening is being used to help fulfill this objective.
I herby agree to submit to a drug screen urinalysis, and I release the Goodwill Fire Co., Inc., its agents and members, and any medical personal acting on its behalf from any and all claims or causes of action arising from obtaining and testing the specimen and releasing the test results to the Goodwill Fire Co., Inc.
I authorize the Goodwill Fire Co., Inc. and physicians, nurses, or medical technicians action on its behalf to obtain a urine specimen to determine whether I have abused drugs or other controlled substances.
The sample will be tested by a federally-certified drug testing laboratory, and the results will be sent to the Medical Review Officer (MRO) for review. After evaluation, the MRO will notify both you and the Goodwill Fire Co., Inc. of the findings. The results will not be released to anyone else.
I further understand that if the MRO determines that the test results were positive, the Goodwill Fire Co., Inc. will not consider me for membership and that any cost incurred for the drug-screening are my responsibility.
