Drug & Alcohol Testing Consent (where permitted)

Creating Lasting Memories Through Beautiful Photography.

Consent form for permitted pre-employment or post-incident testing, with state-law limits (NJ CREAMMA cannabis protections, NY Lab. Law § 201-d, CT Gen. Stat. § 31-51x, PA Act 96).

BTL-PBL-05.024

Form

Vol 05 — Human Resources & Talent

Notice

Testing is administered only for positions and circumstances permitted by law (safety-sensitive roles, reasonable suspicion, post-incident) and in accordance with state law (NJ CREAMMA cannabis protections require a Workplace Impairment Recognition Expert; NY Lab. Law § 201-d and CT Gen. Stat. § 31-51x limit cannabis testing; PA Act 96 protects medical marijuana patients). *

Yes / N/A

Applicant / Employee

Full name *

Position *

Reason for test *— Pre-employment · Reasonable suspicion · Post-incident · Random (if applicable & permitted) · Return-to-duty.

Substances tested— 5-panel, 10-panel, or specific panel as required by law.

Consent

I consent to the collection and testing described above by the Company's designated laboratory and to release of results to the Medical Review Officer and authorized Company personnel. *

Yes / N/A

I have been given the opportunity to disclose prescription medications to the MRO. *

Yes / N/A

Applicant / employee signature *

Date *

Collector / witness signature

Prepared by

Name · Title · Date

Reviewed by

Name · Title · Date

Approved by

Owner · Katheryn L. Wilkins · Date

Controlled document — BTL-PBL-05.024. Complete all required fields (marked *). Retain per Volume 15 retention schedule.