<LocationLetterhead>

Employee Name	<PtFullName>	
Location of Testing		
Date of Testing 	<TodaysDate>	
Time of Testing	<CurrentTime>	
Type of Test	Drug      o	
Test Result:	

Alcohol   o	
Test Result:	

As a result of the testing conducted, you have breached the Warakirri Fitness for Work Policy by failing to achieve a satisfactory result as required by the Fitness for Work Policy and your signed employment contract. You are now being stood down from all duties and will not be allowed to return to work.
You will be subject to a review in order to assess whether your employment will continue with Warakirri.  
Your Supervisor/Manager will allow you to collect your personal belongings and arrange for you to be picked up if necessary.  Transport to your place of residence will be at your own expense.
If you require any further information about this test result or any pending results, please contact the office.
If you have any other concerns regarding your employment conditions, please contact the HR Manager.

  Test conducted by	 Name	  <DrName>	
	 Signature		
  Employee	 Name	  <PtFullName>	
	 Signature		
  Witness	 Name		
	 Signature