Model: HUGHS-R 07-

EMPLOYEE ALCOHOL AND DRUG TEST CONSENT 00

FORM REV 00
DATE: 28-04-16

 
ALCOHOL AND DRUG POLICY ACKOWLEDGEMENT

As an employee of Hughs Constructions Limitada I________________________

acknowledge the Hughs Lda Alcohol and Drug Policy and understand that the use of
drugs, alcohol and other controlled substances in the workplace creates a safety
concern for all employees and I understand that either refusal to submit to a drug test or
failure to qualify according to the minimum standards established by Hughs
Constructions Limitada for alcohol and drug test might disqualify me from further
consideration for employment.

In the interest of creating a safe working environment, I hereby give my consent for the
Hughs Constructions Limitada to conduct the drug and alcohol tests it considers
necessary as outlined in the Alcohol and Drug Test policy.

I authorize Hughs Constructions Limitada to take the necessary specimens or samples

from me to test for drugs, alcohol and other controlled substances, and I authorize
laboratory or medical personnel retained by Hughs Constructions Limitada for these
tests to confidentially release the results for the sole proof of the offense and for
management decision on my employment.

I release the laboratory or medical personnel conducting the drug test, the Hughs
Constructions Lda, and the Hugh’s employees, directors, officers and successors from
any liabilities, claims and causes of action, known or unknown, contingent or fixed, that
may result from these tests and I agree not to file any lawsuits or other actions to assert
a claim.

I have read in full and understand the above statements and conditions of employment.

Employee Hughs Constructions HSE Manager

Print Name: Print Name:
Signature: Signature:

Issuer: Reviewer: Approver: Last update:

HUGHS QHSE Rui HUGHS GM Sean Naidoo HUGHS CEO Chris 28 April 2016
Niquice Grottis
HUGHS QSHE = Quality, Safety, Health, Environment and Security