HomeMy WebLinkAboutVI (C) Resolution No 95-21, establishing a drug free workplace for employees AGENDA 10-17-95
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.f~lfi of coon``iPEGGY PSALEDAKIS,DIRECTOR
PERSONNEL/EMPLOYEE RELATIONS
150 N.LAKESHORE DRIVE•OCOEE,FLORIDA 34761
(407)656-2322•FAX(407)656-8504
MEMORANDUM
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TO: THE HONORABLE MAYOR SCOTT VANDERGRIFT AND MEMBERS OF THE
COMMISSION
FR: PEGGY PSALEDAKIS, DIRECTOR PERSONNEL/EMPLOYEE RELATIONS <
SU: DRUG FREE WORKPLACE RESOLUTION
DA: OCTOBER 12, 1995
We are requesting the adoption of this Resolution for purposes of
implementing a drug-free workplace program that complies with the
Workers' Compensation Statute. The benefits of adopting this
program include: (1) that the City worker' s compensation insurance
rates will be reduced under Florida Statute 627 . 0915, and (2) that
employees who test positive for drugs, or who refuse to submit to
a drug test under such a program forfeit eligibility for medical
and indemnity benefits otherwise available under workers'
compensation laws. Florida Statute 440 . 101; 440 . 102 (2) ;
440 . 102 (7) (e) ; 440 . 102 (12) .
THE PRIDE OF WEST ORANGE 4L
0,
RESOLUTION NO. 95- 21
A RESOLUTION OF THE CITY OF OCOEE, FLORIDA,
RELATING TO IMPLEMENTATION OF A "DRUG-FREE
WORKPLACE" POLICY AS AUTHORIZED BY, SECTION
440. 102, FLORIDA STATUTES, AND CHAPTER 38F-9,
FLORIDA ADMINISTRATIVE CODE; ADOPTING A "DRUG-
FREE WORKPLACE" POLICY; PROVIDING FOR
SEVERABILITY; PROVIDING AN EFFECTIVE DATE.
WHEREAS, the City Commission of the City of Ocoee desires
to provide for a drug-free workplace; and
WHEREAS, the City Commission of the City of Ocoee
believes it is important to establish a "Drug-Free Workplace"
policy to deter use of drugs and alcohol in the workplace and to
provide a safe working environment for all City employees.
NOW, THEREFORE, BE IT ENACTED BY THE CITY COMMISSION OF
THE CITY OF OCOEE, FLORIDA, AS FOLLOWS:
SECTION 1. Authority. The City Commission of the City
of Ocoee has the authority to adopt this Resolution pursuant to
Article VIII of the Constitution of the State of Florida, Chapter
166, Florida Statutes, and Section 440. 102 , Florida Statutes.
SECTION 2 . Adoption of Drug-Free Workplace Policy.
The City Commission of the City of Ocoee, Florida, hereby adopts
the City of Ocoee DRUG-FREE WORKPLACE POLICY as set forth in
Exhibit "A" attached hereto and by this reference made a part
hereof.
SECTION 3. Severability. If any section, subsection,
sentence, clause, phrase or portion of this Resolution is for any
reason held invalid or unconstitutional by any court of competent
jurisdiction, such portion shall be deemed a separate, distinct and
independent provision and such holding shall not affect the
validity of the remaining portion hereto.
SECTION 4. Effective Date. This Resolution shall become
effective immediately upon passage and adoption.
PASSED AND ADOPTED this day of , 1995.
APPROVED:
ATTEST: CITY OF OCOEE, FLORIDA
Jean Grafton, City Clerk S. Scott Vandergrift, Mayor
(SEAL)
FOR USE AND RELIANCE ONLY BY APPROVED BY THE CITY OF OCOEE
THE CITY OF OCOEE, FLORIDA COMMISSION AT A MEETING
APPROVED AS TO FORM AND LEGALITY HELD ON , 1995
this day of , 1995. UNDER AGENDA ITEM NO.
FOLEY & LARDNER
By:
City Attorney
A:UtffiOLLTII10/11/95'CLEMENTS DISKN11SMC:vrs
2
EXHIBIT "A"
DRUG-FREE WORKPLACE POLICY
This is your official notification that The City of Ocoee is implementing a
"Drug-Free Workplace" as authorized by F.S. 440.102 and Chapter 38F-9 of
the Florida Administrative Code. All employees are absolutely prohibited from
unlawfully manufacturing, distributing, possessing or using controlled or illegal
substances in the workplace. It is a condition of employment to refrain from
taking illegal drugs on or off the job.
The City of Ocoee has established this drug-free workplace policy to deter
use of drugs and alcohol in the workplace by establishing standards and
procedures for drug testing of certain employees and job applicants. We
hope this policy will result in a safe working environment for all the City of
Ocoee employees. Drug testing will begin on , which is sixty (60)
days from the date you received your Notice to Employees. Prior to that time,
we urge those of you who believe you may have a drug and/or alcohol
problem to voluntarily seek treatment. Workers' Compensation Drug Testing
Rule 38F-9.010(6) states:
No employer shall discharge, discipline or discriminate against an
employee solely upon the employee's voluntarily seeking treatment
while under the employment of the employer for a drug related
problem if the employee has not previously tested positive for drug
use, entered an employee assistance program for drug related
problems or entered an alcohol and drug rehabilitation program.
Employees will be subjected to the following drug tests:
Job Applicant Testing: All applicants for a position with The City of Ocoee
will be tested and a refusal to submit or a positive confirmed test result will be
used as a basis to reject the applicant for employment at that time.
Reasonable Suspicion Testing: An employee may be required to submit
for testing when the City of Ocoee has a reasonable suspicion, as defined in
the Act, that an employee is using or has used drugs in violation of the
employer's policy. The City of Ocoee has a reason to suspect an employee
when it has an articulable belief that the employee possesses or uses drugs
or alcohol at the workplace; is observed intoxicated or impaired by drugs, or
alcohol has been reported by a reliable and credible source as using drugs;
has tampered with a drug test; has caused or contributed to or been involved
in an accident while at work, or is engaged in abnormal conduct or erratic
behavior while at work, or shows significant deterioration in work
performance. Evidence that an employee has used, possessed, sold,
solicited, or transferred drugs while working. The reason to suspect shall be
based on specific and particular facts and the reasonable inferences drawn
from those facts in light of experience.
Routine Fitness for Duty Testing: An employee may be asked to submit to
a drug test as part of a routinely scheduled fitness for duty medical
examination that is either part of the employer's established policy or that is
scheduled routinely for all members of an employment classification or group.
The City of Ocoee initially establishes two employment classifications which
require routine fitness for duty testing. Those classifications are (1) operators
of hazardous equipment or machinery and (2) City drivers. All employees so
classified must submit to annual testing.
Follow-Up Testing: An employee who in the course of employment, enters
an employee assistance program for drug related problems, or an alcohol and
drug rehabilitation program, may be tested as a follow-up measure and
thereafter on a quarterly, semiannually or annual basis for two (2) years
thereafter.
Drugs Tested: You may be tested for any or all of the following:
Alcohol Amphetamines Barbiturates Benzodiazepines
Cannabinoids Cocaine Methadone Methaqualone
Opiates Phencyclidine Propoxyphene
Reporting Use of Prescription or Non-Prescription Medications: An
employee or job applicant will be able to confidentially report the use of
prescription or non-prescription medications, both before and after being
tested, as presence of those medications in the body may affect the outcome
of the test. A list of the most common medications by brand name, common
name and by chemical name, which may alter or effect a drug test is
attached.
Before a Positive Drug Test Result
If you are experiencing problems with drugs or alcohol, you are encouraged
to contact an Employee Assistance Program. You may use your Employee
Assistance Program or request a referral to another agency. In either case,
the information will be kept strictly confidential. _
If you voluntarily come forward and seek help prior to being required to
submit to a drug or alcohol test, no disciplinary action will be taken against
you. However, you will still be expected to perform your job and report for
work unless your treatment program counselor requires you to miss work.
Enrollment in a treatment program or attending counseling will not grant you a
license to violate any City of Ocoee policies or shield you from disciplinary
action for such violations. The City of Ocoee reserves the right under certain
circumstances including, but not limited to, safety and security to reassign you
to another position.
After you return to work, follow-up testing for drugs or alcohol will occur on a
quarterly, semi-annual or annual basis for a period up to two years. If you
test positive for drugs or alcohol following the completion of the primary phase
of your treatment program, you will be terminated and your unemployment
benefits may be denied. If you do not complete your drug or alcohol
treatment program or do not comply with the terms of your treatment
program, you will be terminated and your unemployment benefits may be
denied.
After a Positive Test Result
If you have a confirmed positive test result, we will send you a letter within
five days of our receipt of notification from the Medical Review Officer
notifying us of your positive test result. The letter will outline your rights and
the manner in which you may challenge a positive test result. You are
responsible for any costs associated with the challenge.
Challenges to Test Results
You have the right to challenge any confirmed positive test result. All
challenges must be filed within 5 working days of receiving notification of such
results. The first stage requires that you explain or contest the result in
writing to the City of Ocoee Personnel Department. If your explanation is
unsatisfactory, you will be notified of such in writing within 15 days of the date
your challenge was received. At that time, you will be provided with a copy of
your positive test result and the name and address of the laboratory. If you
were involved in an accident and denied medical and/or indemnity benefits,
you may file an administrative challenge by filing a Claim for Benefits with a
Judge of Compensation Claims. If no workplace injury occurred, you may
challenge the test result in a court of competent jurisdiction. If you decide to
challenge the test result, it is your responsibility to notify the laboratory that
you are challenging the test result. You will be solely responsible for all costs
associated with such a challenge.
* Within 180 days after written notification of a positive test result, the
applicant/employee shall be permitted by the company to have a
portion of the specimen re-tested, at the expense of the applicant/
employee. This should be explained in detail in the initial letter
of notification to the applicant/employee.
* If the applicant/employee desires to have the specimen tested at
another laboratory, have the first laboratory transfer the specimen to
the second laboratory. The City of Ocoee will not make the transfer.
* The employee/applicant can administratively challenge the results of
a drug test by filing a claim with a Judge of Compensation Claims
within thirty (30) days after receipt of the City of Ocoee's response to
his/her explanation.
Cost of testing
The City of Ocoee shall pay the cost of initial and confirmation drug tests
which it requires of employees. An employee shall pay the cost of any
additional drug tests not required by the City of Ocoee.
Confidentiality
All information, interviews, reports, statements, memoranda, and drug and
alcohol test results, written or otherwise received by the City of Ocoee
through this Policy are confidential communications and will be maintained in
a separate file. The City of Ocoee, any laboratory, Employee Assistance
Program, drug or alcohol treatment program or their agents who receive or
have access to this information concerning drug test results shall keep it
confidential. Release of such information under any other circumstances shall
be solely pursuant to a signed written informed consent form, unless such
release is compelled by a hearing officer or court of competent jurisdiction or
if deemed appropriate by a professional or occupational licensing board in a
related disciplinary proceeding. Additionally, the City of Ocoee, its agent, the
laboratory or treatment program shall not be prohibited from releasing this
information when consulting legal counsel in actions brought under or related
to Section 440.102 Florida Statutes, or when such information is relevant to
its defense in civil or administrative matter.
Consequences of Testing Positive or Refusal to Allow Test
* Job applicants: An applicant who refuses a drug test will not be
hired. An applicant who submits to a drug test which is both
positive and confirmed as positive will not be hired.
* Employed worker who has not been injured: In the event an
employed worker who has not been injured, refuses to submit to a
drug test or is tested positive and confirmed positive may be subject
to one or more of the following requirements:
* Attend educational seminars and courses and participate in
an employee asistance program.
* Require attendance at rehabilitation programs.
* Agree to reasonable discipline which may include job transfer
to a less hazardous position, probationary employment and/or
reduction in compensation.
* Immediate discharge from employment.
* An employed worker who is injured: In the event an employed
worker is injured in the course and scope of their employment
and who refuses to submit to a drug test or who submits and is
tested pursuant to City policy and who has a positive
confirmation of a drug shall:
* Forfeit their eligibility for medical and indemnity
benefits under the Workers' Compensation Act.
* Forfeit their eligibility for unemployment benefits.
* Be terminated from employment.
* Otherwise subject to the sanctions provided above for
an employed worker who is not injured.
Convictions
If you are convicted of any drug related crime (sale, use or possession), you
must notify the City of Ocoee Personnel Department within 5 days of your
conviction. Failure to notify the City of Ocoee of such conviction is grounds
for termination.
Miscellaneous
* A notice of drug testing in vacancy announcements shall be
included for those positions where drug testing is required.
* A notice of the City's drug testing policy shall be posted in an
appropriate and conspicuous location on the City of Ocoee's
premises. Copies of the policy are made available for inspection
during regular business hours by the general public.
* All drug testing will be conducted by The City of Ocoee's
designated laboratory, which is licensed and approved by the
Agency for Health Care Administration. The testing will be
conducted with appropriated chain of custody procedures in
place to ensure accuracy and continuity in specimen collection,
handling and transfer and storage.
* A current resource file of providers of Employee Assistance
Programs including alcohol and drug abuse programs, mental
health providers and various other persons, entities or
organizations designed to assist employees with personal or
behavioral problems shall be maintained. This includes, but
is not limited to, those referenced in "The Florida Comprehensive
Directory, Drug Abuse and Mental Services" published by the
Department of Health and Rehabilitative Services.
* The City of Ocoee will provide an annual education course to
assist employees and/or supervisors in identifying personal and
emotional problems which may result in the misuse of alcohol or
drugs. This course will also include a presentation on the legal,
social, physical and emotional consequences of the misuse of
alcohol or drugs.
* All applicants for employment and employees of the City of Ocoee's
drug program and testing procedures shall be informed of the drug
policy. An applicant is defined as a person who has appllied for
a position with the City of Ocoee and who has been offered a job
contingent upon successfully passing a drug test. Two copies of
the policy's consent form shall be given to applicant; one signed,
dated and returned to the City of Ocoee and one kept by the
employee.
* If the initial test is negative, the City of Ocoee may request a
confirmation test, at the expense of the City. If the initial test
is positive, a confirmation test with the laboratory must be
obtained, at the City of Ocoee's cost.
* The City of Ocoee shall provide the employee or applicant, upon
request in writing a copy of the test results. An employee or
job applicant whose drug test result is confirmed as positive in
accordance with this program shall not, by virtue of the result alone,
be deemed to have a "handicap" or "disability" as defined under
federal, state or local handicap and disability discrimination laws.
* The City of Ocoee shall employ or contract with a medical review
officer (MRO) who is responsible for receiving and reviewing all
confirmation results from a laboratory. This medical review
officer is responsible for contacting all positive tested
individuals to inquire about possible prescriptive or over-the-
counter medications which could have caused a positive result.
The MRO shall notify the City's Director of Personnel and
Employee Relations only of the verbal and written results.
Confidentiality of drug testing shall be maintained.
The City of Ocoee reserves the right to amend, change or alter this Policy
without the consent of its employees.
Over-the Counter and Prescription Drugs that Could Alter
or Affect The Outcome of a Drug Test
Alcohol:
All liquid medications containing ethyl alcohol (ethanol). Read the label
for alcohol content.
Amphetamines:
Obetrol, Biphetamine, Desoxyn, Dexedrine, Didrex
Cannabinoids (marijuana):
Marinol (Dronabinol, THC)
Cocaine:
Cocaine HCI topical solution (Roxanne)
Opiate:
Paregoric, Parepectolin, Donnagel PG, Tylenol with Codeine, Empirin
with Codeine, Aspirin with Codeine, Robitussin AC, Guiatuss AC,
Novahistine DH, Novahistine Expectorant, Dilaudid (hydromorphone), M
S Contin and Roxanol (morphine sulfate, Percodan, Vicodin, etc.)
Barbiturates:
Phenobarbital, Tuinal, Amytal, Nembutal, Seconal, Lotusate, Fiorinal,
Fioricet, Esgic, Butisol, Mebaral, Butabarbital, Phrenilin, Triad, etc.
Bensodiaze fines:
Ativan, Azene, Clonopin, Dalmane, Diazepam, Librium, Xanax, Serax,
Tranxene, Valium, Verstran, Halcion, Poxipam, Restoril, Centrax.
Methadone:
Dolophine, Methadose
Propoxyphene:
Darvocet, Darvon N, Dolene, etc.
If you are being given this list as preparation for a drug or alcohol test,
it is imperative for you to bring a picture ID with you to the collection
site, a Release of Confidential Information form, and to report to the
testing technician any prescribed or over-the counter medications you
have taken during the past thirty days.
DEFINITIONS
The definitions used in this Drug-Free Workplace Policy are those stated in
the State of Florida Department of Labor and Employment Security Workers'
Compensation Drug Testing Rule Chapter 38F-9.
Alcohol means ethyl alcohol (ethanol). References to use of alcohol include
use of any beverage, mixture or preparation containing ethyl alcohol.
Chain of Custody refers to the methodology of tracking specified materials or
substances for the purpose of maintaining control and accountability from
initial collection to final disposition for all such materials or substances and
providing for accountability at each stage in handling, testing, storing and
reporting of test results.
Collection Site means a place where individuals present themselves for the
purpose of providing a specimen to be analyzed for the presence of drugs.
Collection Site Person means a person provided by an approved laboratory
who instructs and assists individuals at a collection site and who receives and
makes an initial examination of the specimen provided by those individuals.
Confirmation test, confirmed test, or confirmed drug test means a
second analytical procedure run on a sample that was positive on the initial
screening test. The confirmation test must be different in scientific principle
from that of the initial test procedure. The confirmation method must be
capable of providing requisite specificity, sensitivity and quantitative accuracy.
The confirmation test for alcohol will be gas chromatography and the
confirmation test for all drugs will be gas chromatography/mass spectrometry.
Controlled Substance is any substance which is not legally obtainable or
which can only be legally obtained by prescription from a licensed medical
practitioner.
CG/MS means gas chromatography/mass spectrometry.
Division means the Division of Worker's Compensation of the Department of
Labor and Employment Security of the State of Florida.
Drug means alcohol, including distilled spirits, wine, malt beverages and
intoxicating liquors, amphetamines, cannabinoids, cocaine, phencyclidine
(PCP), hallucinogens, methaqualone, opiates, barbiturates, benzodiazepines,
synthetic narcotics, designer drugs, or a metabolite of ary substance listed
herein.
Drug Test means any chemical, biological or physical instrumental analysis
administered by a laboratory certified by the United States Department of
Health and Human Services or licensed by the Agency for Health Care
Administration for the purpose of determining the presence absence of a drug
or its metabolites.
Employee means a person who performs services for salary, wages or other
remuneration for an employer and is covered by the Workers' Compensation
Act.
Employee Assistance Program means an established program capable of
providing expert assessment of employee personal concerns; confidential and
timely identification services with regard to employee drug abuse; referrals of
employees for appropriate diagnosis, treatment, and assistance; and follow-up
services for employees who participate in the program or require monitoring
after retuning to work. If, in addition to the above activities, an Employee
Assistance Program provides diagnostic and treatment service, these services
shall in all cases be provided by service providers pursuant to S. 397.311(28).
Employer means a person or entity that employs individuals in Florida and is
covered by the Florida Workers' Compensation Act.
Fitness-for-Duty Testing if you are required to have a fitness-for-duty
physical on an annual or bi-annual basis because of federal, state or other
requirements, a drug test will be included as a part of the physical.
Illegal Substances means any substance which is not legally obtainable or
which is legally obtainable, but has not been legally obtained.
This includes the following drugs: amphetamines, barbiturates,
benzodiazepines, cannabinoids (marijuana), cocaine, methaqualone,
methadone, opiates, propoxyphene and PCP which are used unlawfully
or abused. Unlawful usage refers to the illegal obtaining, possessing
and/or using of a drug as defined by the Controlled Substance Act or
state or local regulations.
This term also includes prescribed drugs not legally obtained,
prescribed drugs not being used for prescribed purposes and over-the-
counter drugs not being used according to the manufacturer's
directions.
Impairment This policy is primarily concerned with the effects of alcohol/drug
use in performance, regardless of when the substances were ingested. This
concern, therefore, considers impairment as not only being under the
influence of a substance, but also the after-effects of usage, e.g., hangover,
withdrawal symptoms, fatigue, etc.
Initial Drug Test means a sensitive, rapid and reliable procedure to identify
negative and presumptive positive specimens. All initial tests shall use an
immunoassay procedure or an equivalent, or shall use a more accurate
scientifically accepted method approved the Agency for Health Care
Administration as such more accurate technology becomes available in a
cost-effective form.
Job applicant means a person who has applied for a position with an
employer and has been offered employment conditioned upon successfully
passing a drug test, and may have begun work pending the results of the
drug test. For a public employer, a "Job Applicant" is a person who has
applied for a special-risk or safety-sensitive position.
Laboratory means a facility, inside or outside the State of Florida, licensed
by the Agency for Healthcare Administration or in certain cases, a facility
certified by the National Institute of Drug Abuse (NIDA) to analyze specimens
for the detection of drugs.
Legal Substance includes any prescribed substance or over-the-counter
medication that has been legally obtained and is being used for the purpose
for which it was prescribed or manufactured.
Employees who lawfully take over-the-counter or prescribed
medications are responsible for understanding how their job
performance may be affected and are responsible for reporting to their
supervisor any potential impairment in their ability to perform their
duties.
Medical Review Officer or MRO means a licensed physician, employed with
or contracted with by an employer, who is responsible for receiving and
reviewing all confirmation results from the laboratory. The MRO is
responsible for contracting all positively tested individuals to inquire about
possible prescriptive or over-the-counter medications which could have
caused a positive test result. The MRO must have knowledge of substance
abuse disorders and have the appropriate medical training to interpret and
evaluate a positive test result with prescriptive or other relevant medical
information.
Non prescription controlled substances means amphetamines;
cannabinoids; cocaine; phencyclidine (PCP); hallucinogens; methaqualone;
opiates; barbiturates; benzodiazepines; synthetic narcotics; designer drugs
obtained without a prescription.
Non prescription medication means a medication that is authorized
pursuant to state or federal law for general distribution and use without a
prescription in the treatment of human disease, ailments or injuries.
Positive Screening Result is a screening result from a urinalysis, blood test
or other controlled substance or alcohol test indicating that controlled
substances or alcohol are present in the employee/applicant's system. A
N IDA-certified impairment in their ability to perform their duties.
Post-Injury testing If you are injured on the job and require medical attention
beyond first-aid, you must submit to a drug and alcohol test. If you could
have caused or contributed to the cause of an injury requiring medical
attention beyond first-aid, you must submit to a drug and alcohol test.
Post-Accident Testing If you caused, could have caused, or contributed to
the cause of an accident where total property damage exceeds $100.00, you
must submit to a drug and alcohol test.
Post Treatment Testing (Follow-up Testing) If you enter the Employee
Assistance Program for drug or alcohol related problems or enter an alcohol
or drug rehabilitation program, you must submit to drug or alcohol testing as a
follow-up to such a program on a quarterly, semi-annual, or annual basis for a
period up to two years.
Prescription medication means a drug or medication obtained pursuant to a
prescription as defined by S.893.02(17).
Public Employer means any agency within the state, county or municipal
government that employs individuals for salary, wages or other remuneration.
Reasonable suspicion drug testing means drug testing based on a belief
that an employee is using or has used drugs in violation of the employers
policy, drawn from specific objective and articulable facts and reasonable
inferences drawn from those facts in light of experience. Among other things,
such facts and inferences may be based upon:
* Observable phenomena while at work, such as direct observation
of drug use or the physical symptoms or manifestations of being
under the influence of a drug.
* Abnormal conduct or erratic behavior while at work or a significant
deterioration in work performance.
* A report of drug use, provided by a reliable and credible source,.
* Evidence that an individual has tampered with a drug test during
his employment with the current employer.
* Information that an employee has cause, contributed to, or been
involved in an accident while at work.
* Evidence that an employee has used, possessed, sole, solicited,
or transferred drugs while working or while on the employer's
premises or while operating the employer's vehicle, machinery
or equipment.
Reason to suspect means an articulable belief that an employee possesses
or uses drugs or alcohol at the workplace, is intoxicated or impaired by drugs
or alcohol, based on specific and particularized facts and reasonable
inferences drawn from these facts in light of experience.
Safety sensitive position means evidence that an employee has used,
possessed, sold solicited, or transferred drugs while working or while on the
employer's premises or while operating the employer's vehicle, machinery, or
equipment.
Special-risk position means, with respect to a public employer, a position
that is required to be filled by a person who is certified under chapter 633 or
chapter 943.
Specimen means a tissue of product of the human body capable of revealing
the presence of alcohol and/or drugs or their metabolites.
Threshold detection level means the level at which the presence of a drug
or alcohol can be reasonably expected to be detected by an initial and a
confirmatory test performed by a laboratory that meets standards established
herein. The threshold detection level indicates the level at which valid
conclusion can be drawn that the drug or alcohol is present in the employee's
sample.
Under The Influence means that the employee is affected by drugs or
alcohol or the combination of drugs and alcohol in a detectable manner. A
determination of such influence can be established by professional opinion, a
scientifically valid test, or in some cases, by a lay person's opinion.
Drug-Free Workplace Policy Summary
Read Carefully, ask any questions and initial each item separately.
I hereby acknowledge that I have received a summary of the
Company's Drug-Free Workplace Policy. I have had the opportunity to
read the Company's Drug-Free Workplace program and receive
satisfactory answers to any questions that I have. I have also received
a copy of the list of over-the-counter and prescription drugs that could
alter or affect the outcome of a drug test.
I know that if I am taking medicine that could affect my ability to perform
my job (i.e., there are warning labels on the container) I must inform my
supervisor immediately.
I know that if I refuse to submit to a pre-employment drug test I will not
be hired and my employment is conditioned upon a negative drug test
result.
I know that total compliance with the Company's Drug-Free Workplace
Policy is a condition of continued employment.
I know that if I refuse a reasonable suspicion, post-injury, post accident,
random, fitness-for-duty or post-treatment drug or alcohol test I may
lose my job, my unemployment benefits, and my workers' compensation
medical and indemnity benefits.
I know that if I am injured or cause or contribute to the cause of an
injury or an accident and test positive for drugs or alcohol I will be
subject to discipline up to and including discharge.
I know that if I enter into a treatment program for drug or alcohol abuse
and test positive for drugs or alcohol following the completion of the
primary phase of my treatment I will be subject to discipline up to and
including discharge.
I know that I have the right to challenge any positive test result and that
I must notify the laboratory that I am challenging the test result.
I know that if I am convicted of a drug related crime I must notify my
supervisor within five working days.
I agree to comply with the drug and alcohol testing requirements of the
Company's Drug-Free Workplace Policy.
I give my informed consent for the release of drug and/or alcohol test
results to the Company.
I know that the Company's Drug-Free Workplace Policy does not
constitute an employment contract between the Company and me.
I have read and understood each of the preceding items that I have
initialed. I have had the opportunity to question any item that I did not
understand. I have voluntarily signed this form.
Employee Date Witness Date
I hereby refuse to submit to a drug test as part of the Company's
Drug-Free Workplace Program.
Employee Date Witness Date