Valdosta, GA

POLICY STATEMENT

The Hospital Authority of Valdosta and Lowndes County, Georgia (Hospital Authority)
requires all employees to report to work without any alcohol or illegal, mind-altering or
unauthorized controlled substances (drugs) in their system. We also will not tolerate
employees manufacturing, using, selling, possessing, distributing, or dispensing or
making arrangements to distribute illegal drugs or other unauthorized controlled
substances while at work or on Hospital property or otherwise engaged Hospital duties.
Further, outside conduct which affects your work, your relationship with patients, co-
workers or the public, or reflects badly on the Hospital is prohibited. Violation of these
rules will subject you to discipline, including discharge.

In order to enforce these rules, we reserve the right to require employees to submit at any
time to urinalysis, blood, breath, or other tests to determine the presence of prohibited
substances. We will utilize confirmation tests and careful collection and testing
procedures to ensure that we obtain an accurate result. We also reserve the right to search
desks, cabinets, toolboxes, vehicles, bags or any property at the Hospital or in its
vehicles. Refusal to cooperate with the Hospital in any investigation will result in
discipline, including discharge.

I HAVE READ AND UNDERSTAND the above statement of policy and I agree to
abide by the policies. I consent to submit to urinalysis or other drug or alcohol test at any
time as a condition if my initial or continued employment. I authorize any laboratory or
medical provider to release test results to agents or employees of the Hospital Authority. I
release any legal claims I may have against the Hospital Authority, its officers, agents
and employees of requiring tests or test results. I understand that this agreement in no
way limits my, or Hospitals right to terminate employment at any time for any reason.


My typed name below shall have the same force and effect as my written signature:

___________________________ ___________________________
Employee Name Department

___________________________ ___________________________
Employee Signature Date

___________________________ ___________________________
Hospital Authority Representatives Date
Signature