KD-OH-DA-006
Drug and Alcohol Policy Statement and Testing Record
A one-page drug and alcohol policy statement for the employer to adopt — the rule, with-cause, post-incident and random testing, consent, refusal, outcome and confidentiality — followed by the record of a single test: the grounds as observed, the consent, the provider, the chain of custody and the outcome, with no substance detail held on the sheet.
2 pages · 51 fillable fields · works in Adobe Reader, Preview, Chrome, or on a phone — or complete it online in your browser and download the finished document.
Page 1 of 2 — click to enlarge
Read all 2 pages first — watermarked sample, no email Before you submit: the checklist
Statutory basis, cited on the form
- HSWA 1974 ss.2 and 7
- MHSWR 1999 reg 3
- Data Protection Act 2018 and UK GDPR
What it is not
It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and sign it off. See why we don't say "compliant".
Format
AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.
This revision was prepared against legislation current at 10 August 2026. Revision A0. Check kubitdocs.com/revisions for the current revision before use.
More in Occupational health
10 documents