1990-06-11 Regular Meeting of La Porte City Council

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e e TEST CONSENT IN REASONABLE CAUSE AND POST-ACCIDENT SITUATIONS The City's drug abuse policy provides that an employee may be required to submit to a urine drug and/or blood plasma test (1) when the employee's performance or behavior on the job would cause a reasonable person to believe that the employee is under the influence of a chemical substance, such as drugs or alcohol, or (2) when an employee has been directly involved in an accident resulting in property damage or personal injury. Reasonable cause has been shown to believe that you may be under the influence of a chemical substance, or that you have been directly involved in an accident resulting in property damage or personal injury. EMPLOYEE: I am aware of the City's drug abuse policy referred to above. I understand that I cannot be compelled to submit to a urine or blood plasma test, but that if I refuse I may be subject to disciplinary action, including discharge or disbarment from the workplace. I understand that if the results of such tests reveal an unexplained presence of a chemical substance in my body I may be subject to disciplinary action, including discharge or disbarment from the workplace. I hereby consent to a urine and/or blood plasma test, and I give consent to the City and its agents, including the collecting and testing agencies, to disclose and discuss the results of such tests as they relate to me. I further agree to hold the City and its agents harmless from any and all liability in connection with such tests. To assist in the analysis of my urine and/or blood, please be informed that I have used on the dates indicated the following named chemical substances, legal or illegal drugs, prescription or non-prescription medicines, synthetic or look-alike drugs, or alcohol. NAME OF SUBSTANCE TAKEN: DATE LAST USED: (Date) (Signature of Employee) (Signature of Witness) (Printed Name of Employee)