EMPLOYEE NOTICE AND ACKNOWLEDGEMENT FOR TESTING AFTER REHABILITATION

PART 1: NOTICE

The company/organization is pleased to learn that you are returning to duty after successfully completing an approved program of drug and/or alcohol rehabilitation.

In accordance with the company's/organization's drug-and alcohol-free workplace program, you will be subject to a reasonable program of follow-up drug and/or alcohol testing without prior notice for not more than 60 months after return to duty.

This program of follow-up testing will be in addition to the other testing requirements imposed on all employees, such as reasonable cause testing, post-accident testing and random testing.

PART II: ACKNOWLEDGEMENT

I acknowledge receipt, understanding and acceptance of the above written notice.

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(Signature)                                     (Date signed)

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(Printed name)                                  (Signature of witness)

Note: This form should be customized with your company or organization's name and should reference only drugs or alcohol, or both, depending upon which options you select for testing requirements.