Template

Drug and Alcohol Screening Consent Form

by Daniel Gray, from the Community

This Drug and Alcohol Screening Consent and Chain of Custody form helps workplaces collect informed consent and maintain clear custody of samples during testing. It captures donor information, company and contact details, consent declarations, and collector certification. Record device and batch details, dates, and initial results across multiple drug classes (e.g., THC, AMP, OPI, BZO). Includes prompts for medication disclosure and sample integrity to support compliance.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Drug and Alcohol Permanent Screening Record
This template helps mining companies document permanent employee drug and alcohol tests. Capture test location, date, donor and collector details, medication declarations, breath alcohol device IDs and readings, and multi-panel drug screen outcomes (THC, COC, OPI, METH, AMP, BZO, OXY). Include consent acknowledgments, signatures, and follow-up requirements to ensure compliance with site policies and safety regulations. Use this record to standardize screening, support audits, and maintain a clear chain of custody.
by Kelly Jensen, from the Community
Downloads: 10+
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Template
Drug and Alcohol Testing Consent Form
Use this form as consent for conducting Drug and Alcohol Testing
by SafetyCulture
Downloads: 200+
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Template
Burbank Group Alcohol and Drug Test Log
This Burbank Group Alcohol and Drug Test Log helps teams record workplace testing for alcohol and drugs. It captures preliminary declarations, induction and policy acknowledgments, medication details, and informed consent. The form supports alcohol breath testing and oral fluid drug screening across common panels including THC, cocaine, methamphetamine, MDMA, amphetamines, opiates, and benzodiazepines. Fields include test type and readings, notes for non negative markers, photos of results, and space for supervisor and site details. Use this log to standardize procedures, document chain of custody at site level, and strengthen health and safety compliance on construction projects.
by Frank Perconte, from the Community
Downloads: 0
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Template
Random Drug and Alcohol Test Checklist
This random drug and alcohol test checklist helps workplaces conduct compliant screenings and keep clear records. Capture test details including location, date, type of test and equipment used. Record employee identification, witness selection, and pre-screening questions on recent alcohol or drug use, medications, and timing. Document mouth swab screening as the primary sample, results, employee comments, and actions taken if positive. Include signatures from the employee and company representative to complete the audit trail.
by natalie cavanagh, from the Community
Downloads: 10+
Get

Drug and Alcohol Permanent Screening Record

This template helps mining companies document permanent employee drug and alcohol tests. Capture test location, date, donor and collector details, medication declarations, breath alcohol device IDs and readings, and multi-panel drug screen outcomes (THC, COC, OPI, METH, AMP, BZO, OXY). Include consent acknowledgments, signatures, and follow-up requirements to ensure compliance with site policies and safety regulations. Use this record to standardize screening, support audits, and maintain a clear chain of custody.

by Kelly Jensen, from the Community

10+

Get

Template

Drug and Alcohol Testing Consent Form

Use this form as consent for conducting Drug and Alcohol Testing

by SafetyCulture

200+

Get

Template

Burbank Group Alcohol and Drug Test Log

This Burbank Group Alcohol and Drug Test Log helps teams record workplace testing for alcohol and drugs. It captures preliminary declarations, induction and policy acknowledgments, medication details, and informed consent. The form supports alcohol breath testing and oral fluid drug screening across common panels including THC, cocaine, methamphetamine, MDMA, amphetamines, opiates, and benzodiazepines. Fields include test type and readings, notes for non negative markers, photos of results, and space for supervisor and site details. Use this log to standardize procedures, document chain of custody at site level, and strengthen health and safety compliance on construction projects.

by Frank Perconte, from the Community

Get

Template

Random Drug and Alcohol Test Checklist

This random drug and alcohol test checklist helps workplaces conduct compliant screenings and keep clear records. Capture test details including location, date, type of test and equipment used. Record employee identification, witness selection, and pre-screening questions on recent alcohol or drug use, medications, and timing. Document mouth swab screening as the primary sample, results, employee comments, and actions taken if positive. Include signatures from the employee and company representative to complete the audit trail.

by natalie cavanagh, from the Community

10+

Get

Drug and Alcohol Screening Consent Form

About author

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Drug and Alcohol Permanent Screening Record

Drug and Alcohol Testing Consent Form

Burbank Group Alcohol and Drug Test Log

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Drug and Alcohol Permanent Screening Record

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