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• NOTICE OF DRUG OR ALCOHOL TEST RESULTS <br /> EMPLOYEE NAME: <br /> DATE RESULTS RECEIVED FROM TESTING COMPANY: <br /> CHECK AS APPROPRIATE: <br /> The result of your -initial screening test was negative. <br /> The result of your initial screening test was positive. <br /> The result of your confirmatory test was negative. _ <br /> The result of your confirmatory test was positive.. <br /> RIGHTS OF EMPLOYEE OR JOB APPLICANT IF CONFIRMATORY TEST IS <br /> POSITIVE• <br /> 1. The employee or job applicant has the right to request and <br /> receive from the employer a copy of the test result report. <br /> ® 2. Within three working days after notice of a positive test <br /> result, the employee or job applicant may submit information <br /> to the employer, in addition to any submitted prior to a <br /> test, to explain the test result. <br /> 3. Within five days after notice of a positive test, the <br /> employee or job applicant may request a confirmatory re-test <br /> of the original sample at the employee's or job applicant's <br /> expense. Within three days after receiving the employee's <br /> or job applicant's re-test request, the employer shall <br /> notify the testing agency of the employee's or job <br /> applicant's request. The employee or job applicant may <br /> request a different testing agency licensed under Chapter <br /> 181 (Minnesota State Statute) . If the confirmatory re-test <br /> does not confirm the original positive test result, no <br /> adverse personnel action based on the original confirmatory <br /> test may be taken against the employee or job applicant. <br /> I have received a copy of this completed document. <br /> SIGNED: <br /> DATED: <br /> ,y <br />