Laserfiche WebLink
<br />DRAFT <br /> <br />LAST NAME: <br /> <br />TEST # <br /> <br />CITY OF PARIS <br />CONTROLLED SUBSTANCE AND ALCOHOL SCREENING RESULTS <br /> <br />3. <br /> <br />All substances listed must be tested and marked as a pass or fail. <br />Contact person listed on authorization sheet with verbal confirmation of results as soon <br />as possible. <br />Mail authorization letter and this completed form to the City of Paris Personnel <br />Department as soon as possible. <br />Positive results require immediate notification of the listed contact person and <br />automatic confirmation testing. <br /> <br />l. <br />2. <br /> <br />4. <br /> <br />SUBSTANCE PASS FAIL <br />ALCOHOL <br />CANNABINOIDS (CARBOSY - THC) <br />PHENCYCLIDINE (PCP) <br />OPIATES <br />PROPOXYPHENE <br />AMPHETAMINES <br />BENZO D IAZEPINES ' <br />BARBITURA TES <br />COCAINE MET ABO LITES <br />INHALANTS <br /> <br />Failure of one or more of the controlled substance and alcohol abuse tests will <br />disqualify an incoming employee, and may be "Just Cause" for discharge of an employee of <br />the City of Paris. <br /> <br />~ <br /> <br />PASS I I FAIL <br />Specimen forwarded to second testing facility for GC/MS confirmation: <br /> <br />~ <br /> <br />I <br /> <br />I <br /> <br />YES <br /> <br />N/A <br /> <br />TEST ADMINISTRATOR <br /> <br />DATE <br /> <br />TESTING FACILITY <br /> <br />83 <br /> <br />Rev. 10/27/04 <br />