Model Safety Program
DATE: _______________
SUBJECT: Drug-Free Workplace Program
REGULATORY STANDARD: 1988 Drug-Free Workplace Act and State Requirements
RESPONSIBILITY: The Policy Coordinator is _____________________. He/She is solely
responsible for all facets of this program and has full authority to make necessary decisions to
ensure success of the program. The Policy Coordinator is the sole person authorized to amend
these instructions and is authorized to initiate disciplinary or employee assistance actions as
required by this program. The Company Employee Assistance Program Administrator is
____________________________.
He/She is responsible for training employees and
supervisors, notifying employees of drug testing results and providing assessment, referral and
counseling to employees on a confidential basis who have either tested positive for drugs/alcohol
or who have requested assistance.
*Decision Point: Review State Guidelines for Accuracy and Completeness
Contents Of The Drug-Free Workplace Program
1.
2.
3.
4.
5.
6.
Written Program.
Statement of Commitment.
Corporate Policy.
Types of Testing Required.
Reporting of Results
Employee - After a Positive Test Result
7. Searches
8. Employee Assistance Program (EAP)
9. Confidentiality
10. Education and Training
11. The Drug-Free Workplace Act Basics
12. Definitions
(YOUR COMPANY)’s Drug-Free Workplace Program
1. Written Program. (YOUR COMPANY) will review and evaluate this standard practice
instruction under the following conditions:
1.1
1.2
1.3
1.4
1.5
On an annual basis.
When changes occur to the 1988 Drug-Free Workplace Act (Government Employers).
When changes occur to local directives.
When facility operational changes occur.
When the Plan fails.
Effective implementation of this program requires support from all levels of management within
this company. This Plan will be communicated to all personnel that are affected by it. It
encompasses the total workplace, regardless of number of workers employed or the number of
work shifts. It is designed to establish clear goals, and objectives.
2. Statement of Commitment. (YOUR COMPANY) is committed at all levels to providing a
safe work place for our employees. The use of alcohol and drugs on the job negatively effects
the productivity, the safety and the stability of the workplace. (YOUR COMPANY) will not
tolerate any deviations from the corporate Drug-Free Workplace Program. Employees are
expected and required to report to work on time and in appropriate mental and physical condition
for work. It is our intent and obligation to provide a drug-free, healthful, safe and secure work
environment.
3. Corporate Policy. (YOUR COMPANY) prohibits on-the-job use of illegal drugs or alcohol,
coming to work under the influence, and possessing or distributing drugs on company premises.
Violations of this Policy will result in disciplinary action up to and including discharge.
Employees are encouraged to seek assistance from community resources on a voluntary basis for
substance abuse related problems.
3.1 Management may refer employees with drug problems to specialists for assistance,
however, these employees will still be expected to correct the behavioral and/or the
performance problems which caused the referral.
3.1.1 In handling suspected substance abuse problems, the managers’ and
supervisors’ role is to document problems with performance and behavior,
informing employees that professional assistance for personal problems is
available.
3.2 Legal Drug Policy. Although the primary scope of the (YOUR COMPANY)
Substance Abuse Policy is the use of illegal drugs and abuse of alcohol, we are also
concerned with employees whose performance at work may be impaired by taking
prescription drugs and over-the-counter drugs which have been legally obtained.
Employees need to be sensitive to the fact that the proper use of some legally obtained
medication can cause effects which might place them and fellow employees in jeopardy.
3.2.1 Any questions concerning the effect of a medication while at work should
be directed to the employee’s Supervisor/Group Leader who will then either make
a decision or refer the employee to a company (or contracted) nurse or physician.
3.3 Illegal Drug/Alcohol Policy. The possession or use of illegal drugs and/or alcoholic
beverages at any (YOUR COMPANY) work site is strictly prohibited. Furthermore,
anyone who works at or visits such sites must not be impaired by drug/alcohol use (not
able to perform his/her job in an ordinary and careful manner).
3.3.1 If alcohol is served at social activities sponsored by (YOUR COMPANY),
preparations must include steps to encourage safe and responsible use among
those who choose to use alcohol.
3.3.1.1 Alcohol may be used only with prior approval at sanctioned
company functions and while entertaining customers. Employees are
expected to show appropriate restraint. Employees who show signs of
intoxication will be asked to leave, and protective transportation arranged.
Note: If the corporation is alcohol free the following statement can be substituted for 3.3.1 and
3.3.1.1: Use of alcohol at company functions, on company time, on company property, or during
breaks/lunch is prohibited.
*Decision Point: Review State Guidelines for Accuracy and Completeness
3.3.2 Alcohol impairment is defined as having a blood alcohol level of
__________ percent (0.04 is the customary threshold percentage level) or higher
present anytime while at work.
3.3.2.1 Alcohol level tests will be conducted using a blood level test or
breathalyzer alcohol test administered by a DHHS (Department of Health
and Human Services) certified laboratory.
3.3.3 Illegal drug impairment is determined by the following events:
3.3.3.1 Drugs that will be tested for are those that are most commonly
used and abused: cocaine, phencyclidine (PCP), opiates, amphetamines,
and cannabinoids (marijuana). See Appendix A. The Process of Drug
Testing, for the methodology that will be used to ensure proper
protocol/chain of command and testing methods for all samples.
3.3.3.2 Confirmation tests. The first test of a urine sample is called an
initial test. This test is fairly accurate and reliable but can also detect overthe-counter medications. Therefore, if the initial test is positive, a second
test (by gas chromatography/mass spectrometry, or GC/MS) will be
administered. All confirmation tests will be conducted by a DHHS
certified laboratory.
3.3.3.3 DHHS Cut-Off Levels. A cut-off level is a value that is used to
determine whether a drug test is positive or negative.
(YOUR
COMPANY) will use the cut-off levels established by the Department of
health and Human Services (see Table 1). These cut-off levels have been
proven accurate and reliable, as well as defensible in a court of law.
*Decision Point: Review State Guidelines for Accuracy
TABLE 1. DHHS Cut-Off Levels
Initial
Confirmatory
Cocaine
Phencyclidine
Opiates
Amphetamines
300 ng/ml
25 ng/ml
300 ng/ml
1000 ng/ml
150 ng/ml
25 ng/ml
300 ng/ml
500
Cannabinoids
100 ng/ml
15 ng/ml
ng/ml
3.3.4 If there is reasonable suspicion to believe that an employee may be impaired
the employee may be asked by a supervisor to submit to a drug and alcohol
screening.
3.3.4.1 Failure to submit to such a screen may result in disciplinary action
up to and including discharge.
3.3.4.2 Non-corporate personnel may be asked to leave the premises.
3.4 Policy Statement. See Appendix B for the Employee Notification Letter used by
(YOUR COMPANY). This letter will be provided to all employees along with the
Corporate Drug-Free Workplace Policy Statement (see Appendix C).
Note: Appendices C1 - C5 Provide examples of Corporate Drug-Free Workplace Policy
Statements. Your Policy Statement may be adapted using any one of them or parts of all five.
3.4.1 (YOUR COMPANY)’s Drug-Free Workplace Policy Statement will be
provided to new employees when hired and to all current employees.
3.5 All employees will submit a signed and witnessed Substance Abuse Policy
Acknowledgment Form as a condition of employment. See Appendix D “Drug-Free
Workplace Policy Acknowledgment Form.”
3.6 Employees must disclose any conviction for a drug related offense in the workplace
to (YOUR COMPANY) within 5 days after such conviction. Failure to comply with this
Policy will result in disciplinary action up to and including discharge.
4. Types of Testing Required. The types of testing an employee or job applicant may be
required to submit to and the criteria used to determine when such a test will be required is as
follows:
4.1 Pre-Employment Screening. All job applicants (or - All job applicants selected for
hire) will be tested for illegal drugs as a condition of employment. Any applicant who
refuses to be tested or who has a confirmed positive test will be denied employment
consideration for a minimum of twelve months.
4.2 Employee Testing. Any employee who refuses to be tested on site or does not arrive
at the testing facility within 24 hours will be suspended from their job with the intent to
terminate pending a Pre-Termination Meeting.
4.2.1 Reasonable Cause or Suspicion. Drug testing that is applied to current
employees when there is observable, objective data to suggest that an employee
may be under the influence of, or that his/her job performance is impaired by
alcohol or other drugs. If there is reasonable suspicion of substance abuse or
misuse, (YOUR COMPANY) may require testing of current employees.
Reasonable suspicion may include but is not limited to the following: change in
work performance patterns, change in physical appearance and/or behavior, and
an incident or an accident.
4.2.1.1 Any employee who reports to work and based on the observation
of at least two responsible individuals appears to be under the influence of
alcohol or an unauthorized drug, will be asked to leave the premises. If
necessary , a family member will be contacted to escort the employee
home or another employee will do the same to ensure the safe
transportation of the employee. Prior to leaving the premises the employee
will be directed to take an immediate alcohol and drug screening test to
determine if unauthorized drugs or alcohol was the cause of the problem,
or if another medical problem may exist.
4.2.1.2 Any employee who is involved in an on-the-job accident may be
directed to take a drug and alcohol screening test before returning to work
if, in the view of management, drugs and/or alcohol may have been a
contributing factor. This Policy applies to accidents whether or not injury
or loss of property occurs. However, drug and alcohol testing will be
mandatory when an employee’s actions cause any accident which results
in personal injury requiring medical care or damage to property.
4.2.2 Periodic, Scheduled or Random Testing.
4.2.2.1 (YOUR COMPANY) may direct at anytime that every employee
or a randomly selected group of employees of the company submit to a
drug and/or alcohol screening test. This will occur at an unannounced
time and take place on company property by an approved testing company.
4.2.2.2 An accurate account will be kept of those employees who have
been tested and those who have not because of absence at the time of the
test or for any other reason.
4.2.2.3 Any employee who misses this required testing will be contacted
at home or as soon as he or she returns to work. The employee will then
be informed that he/she must report to the local testing facility within 24
hours of being so informed to have the required screening performed.
4.2.3 Random Testing. Random substance testing for a selected group may be
instituted as follows:
4.2.3.1 For employees who have undergone or are undergoing treatment
for substance abuse or misuse.
4.2.3.2 For employees in safety-sensitive or security-sensitive jobs. A list
of these job titles is provided below:
SAFETY-SENSITIVE JOBS LISTING
SECURITY SENSITIVE JOBS LISTING
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
4.2.3.3 Where necessary to comply with federal or state laws or
regulations.
5. Reporting of Results
5.1 Any employee who has been required to take a drug and alcohol screening test will
be informed of the results.
5.2 The results will be given to the Employee Assistance Program (EAP) Administrator
who will notify the employee by sending the results to the employee’s home address.
5.3 If the test is positive, the employee will be suspended with the intention to terminate
pending a Pre-Termination Meeting.
6. Employee - After a Positive Test Result The following steps must be taken by any
employee who is found to be under the influence of either alcohol or unauthorized drugs
following a screening in accordance with this Policy.
6.1 Any employee who has a positive test will be contacted by the EAP Administrator
to setup an assessment appointment at an early date.
6.1.1 Any employee who fails to set up or keep an appointment will be placed on
suspension with the intention to terminate pending a Pre-Termination Meeting.
6.2 After one or several meetings with a qualified counselor for the EAP, a course of
treatment may be recommended by the EAP counselor. See appendix E. Last Chance
Agreement. Any employee with a positive drug/alcohol test must sign and comply with
the Last Chance Agreement or be placed on suspension with the intention to terminate
pending a Pre-Termination Meeting.
6.2.1 The EAP counselor will be responsible to follow the progress of the
treatment.
6.2 If the employee fails to continue the program of treatment agreed upon, the
Policy Coordinator will be informed of the situation and the employee will be
placed on suspension with the intention to terminate pending a Pre-Termination
Meeting.
7. Searches (YOUR COMPANY) reserves the right to search employees, visitors, lockers,
personal effects, cars and work areas. The company does not intend to implement such searches
in an arbitrary or indiscriminate manner.
8. Employee Assistance Program (EAP) The (YOUR COMPANY)’s Employee Assistance
Program will provide the employer with a system of dealing with employees whose job
performances are declining due to unresolved personal problems including alcohol or other drugrelated problems, marital problems, or legal or financial problems.
8.1 Employees are encouraged to request assistance through the EAP. Participation will
be confidential.
8.2 Participation in the EAP does not relieve the employee from job expectation
requirements.
8.3 The EAP is primarily focused on the rehabilitation of employees suffering from
alcohol or drug addiction and through the direction of the Employee Assistance Program
Administrator will provide the following:
8.3.1 A professional chemical dependency evaluation to every employee given the
opportunity for job retention through a last chance agreement (See Appendix E)
after being found in violation of the employer’s Drug-Free Workplace Policy.
8.3.2 Refer the employee for appropriate treatment as indicated by the evaluation.
Such treatment will be provided only by treatment programs that provide an
individualized treatment plan including a two-year continuing care component.
8.3.3 Monitor the employee’s progress both while in treatment and during the
period of the last chance agreement, modifying the continuing care provisions as
clinically indicated , and
8.3.4 Notify the employer when an employee is not substantially compliant with
the requirements of the last chance agreement, including ongoing treatment and
continuing care recommendations.
8.4 Services provided by the EAP will normally be provided in a face-to-face manner by
staff who are:
8.4.1 Certified as chemical dependency counselors by the National Association of
Drug Abuse Counselors (NAADAC), the International Certification Reciprocity
Consortium/ Alcohol and Drug Abuse (ICRC), the Chemical Dependency
counselor Certification Board, or the Northwest Indian Alcohol/Drug Specialist
Certification Board, or qualified to perform Substance Abuse Professional (SAP)
duties per regulations of the U.S. Department of Transportation.
8.5 To encourage employee self-referral to the EAP outside of drug-free workplace
Policy violations (YOUR COMPANY) will:
8.5.1 Notify employees of the benefits and services of the EAP.
8.5.2 Publish notice of the EAP in conspicuous places and explore effective
means of publicizing the services.
8.5.3 Provide employees with notice of the policies and procedures regarding
access to and use of the EAP
9. Confidentiality
9.1 All information involving medical examinations, drug or alcohol test results or
treatment procedures will be treated as confidential information and will be accessible
only to those company officials and designated medical and professional persons with a
specific need to know.
9.2 Drug/Alcohol test results or treatment procedure information will not be provided to
any other party without the written consent of the employee, except as required by state or
federal laws.
10. Training and Education. The purpose of employee substance abuse training and education
is to ensure that all employees are informed about substance abuse in general, and its effects in
the workplace. Supervisors must be trained in the variety of responsibilities that they have
within a drug-free workplace program.
10.1 Employee Education. (YOUR COMPANY) will provide all employees with an
annual education program covering substance abuse and its effects on the workplace. The
education program should be at least one hour in length and will include as a minimum
the following information:
10.1.1 An explanation of the disease model of addiction for alcohol and drugs.
10.1.2 The nature of alcohol or other drug abuse and some ways addiction can be
treated.
10.1.3 How to recognize a potential alcohol or other drug problem of coworkers,
family members, or friends (what to do and what not to do). See Appendix F.
Where to Find Help.
10.1.4 The effects and dangers of the commonly abused substances in the
workplace.
10.1.5 (YOUR COMPANY)’s policies and procedures regarding substance abuse
in the workplace including the consequences of any violations.
10.1.6 How to access (YOUR COMPANY)s Employee Assistance Program (if
applicable, or referral to other local resources within the community).
10.1.7 How employees who wish to obtain substance abuse treatment can do so
10.1.8 (YOUR COMPANY) will make reasonable efforts to help employees who
have difficulty communicating in English understand the essence of the education
program.
10.2 Training for Supervisors. Supervisors must play a central role in an effective DrugFree Workplace Program. More than anyone else in the organization, they are in a
position to recognize changes in an employee’s job performance. Education for
supervisors will as a minimum contain the following elements:
10.2.1 A thorough understanding of the Drug-Free Workplace Policy to include:
10.2.1.1 The rationale for the Policy - what the law requires, why the
program is important to (YOUR COMPANY), and the cost of alcohol and
other drug problems in the workplace.
10.2.1.2
The specific details of the program, its start-up and
implementation.
10.2.2 How to recognize and deal with employees who have job performance
problems that may or may not be related to alcohol or other drugs, including
personal and family problems.
10.2.3 The supervisor’s specific responsibilities for initiating and carrying out the
drug-free workplace Policy and program.
11. The Drug-Free Workplace Act Basics (YOUR COMPANY) is subject to the 1988 DrugFree workplace act, which requires Federal grantees and recipients of Federal contracts of
$25,000 or more to comply with the following:
11.1 (YOUR COMPANY) must have a written Policy that explains what is prohibited
and the consequences of violating that Policy.
11.2 Employees must read and consent to the Policy as a condition of employment on the
project.
11.3 (YOUR COMPANY) must have an awareness program to educate employees about
alcohol and other drug abuse and addiction, (YOUR COMPANY)’s Policy , and available
help, counseling, and assistance.
11.4 Employees must disclose any conviction for a drug related offense in the workplace
to the Federal agency with which the employer has a grant or contract within 10 days after
receiving notice from the employee or others.
11.5 Employers must make an ongoing effort to maintain a workplace free of drugs.
12. Definitions
12.1 Unauthorized Drug - Any drug that cannot be obtained legally or has been illegally
obtained, including prescription drugs obtained without a prescription, prescribed or overthe-counter drugs used other than as properly instructed and drugs represented as being
illegal.
12.2 Authorized Drug - Prescribed drugs that are used as prescribed by a medical
professional or over the counter drugs used as intended by the manufacturer.
12.3 Under the Influence - For the purpose of this Policy, that the employee is affected
by an unauthorized drug or alcohol in any detectable amount (this detectable level can be
altered in your Policy to reflect acceptable threshold levels).
12.4 EAP - The Company’s designated Employee Assistance Program which is available
to provide assessment, referral and counseling on a confidential basis.
12.5 Policy Coordinator - The individual designated by the Company President to
administer the requirements of this Policy
12.6 Pre-Termination Meeting - A meeting established to deal with any employee who
has been placed on suspension with the intention of termination because the employee has
failed to comply with this Policy. The suspended employee will be allowed to meet with
at least two management employees, one of whom must be the Policy Coordinator. This
meeting will determine if there are any extenuating circumstances which would allow
reconsideration of the termination decision.
12.7 Benefits - Only (YOUR COMPANY) employees and dependents who are covered
by our current health benefit plan are eligible for chemical dependency treatment benefit
coverage. Employees who are covered under other benefit plans will be covered under
the same coordination of benefits Policy as authorized by our current health benefit plan.
12.8 Alcohol - Means ethyl alcohol, hydrated oxide of ethyl, or spirits of wine, from
whatever source or by whatever process produced.
12.9 Alcohol Test - Is a chemical, biological or physical instrumental analysis
administered for the purpose of determining the presence or absence of alcohol within an
individual’s body systems
12.10 Drug - Means amphetamine, cannabinoids, cocaine, phencyclidine (PCP),
methadone, methaqualone, opiates, barbiturates, benzodiazepines, propoxyphene, or a
metabolite of any such substance.
12.11 Drug Test - Is a chemical, biological, or physical instrumental analysis
administered on a specimen sample for the purpose of determining the presence or
absence of a drug or its metabolite within the sample.
12.12 Last-Chance Agreement - Is a notice to an employee who is referred to the
Employee Assistance Program due to a verified positive alcohol or drug test or for
violating an alcohol or drug-related employer rule that states the terms and conditions of
continued employment with which the employee must comply.
Appendix A. The Process of Drug Testing
THE PROCESS OF DRUG TESTING
Reliability of the Test Results
The testing process is two -fold
 The accuracy of the EMIT first test (initial test) ranges between 92-98%
 The accuracy of the confirmatory test, the gas chromatograpy/mass spectrometry (GC/MS), is
virtually 100% accurate from a scientific standpoint
Elements of the Protocol/Chain-of-Custody
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The Donor will be required to show a picture I.D. at the time they report for the test.
The collection site personnel will complete paperwork directly from the picture I.D. and will
refuse to administer the test if no such I.D. is presented.
The Donor will be instructed to wash his/her hands.
The Donor will be instructed to remove any hat, coat, or outer clothing which could conceal
efforts to adulterate the urine specimen.
The Donor will not be able to take a purse, parcels or belongings other than a wallet into the
restroom. If the Donor wishes, the collector will provide a receipt for the belongings.
The collector will accompany the Donor to the restroom, but will not go into a single facility
restroom with the Donor. If a multi-stall restroom is used , the Collector will go into the
restroom with the Donor but will not go into the stall. If a collector goes into a multi-stall
bathroom, the Collector will be the same sex as the Donor.
The Donor will urinate into the disposable specimen cup, and will bring cup to Collector
immediately after voiding.
The Donor should flush toilet only when instructed to do so by the Collector.
The Donor will be given the opportunity to wash their hands again after collection.
The Collector will take the temperature of the specimen. This must be done within four
minutes of voiding.
If a split sample is required, the Collector will split the sample and will send both specimen
bottles for testing to the testing laboratory.
If there is less than 30 ml in the specimen, the Donor will be required to repeat the process.
In the presence of the Donor, the specimen temperature and additional documentation will
be completed.
Also in front of the Donor, the specimen will be transferred into the storage bottle and
securely sealed to prevent tampering.
All process steps will be completed in front of the Donor and the Donor will be required to
initial several steps to verify their observation.
The Donor will verify their understanding and observation of the process which readies the
specimen for transporting to the laboratory.
The Donor will be given a copy of paperwork and instruction that they will be contacted by
the Medical Review Officer (MRO) if any further information is needed.
Appendix B. Sample Employee Notification Letter
To: (Employee’s Name)
Subject: Implementation of a Drug-Free Workplace Program
The abuse of drugs and alcohol is a national tragedy that can be linked to many of the social,
health and economic problems facing our country today. some of these problems may be
affecting employees who work for (YOUR COMPANY) or may be working for us in the future.
Because of the urgent need to address these problems, (YOUR COMPANY) has developed the
attached Drug-Free Workplace Policy.
The foundation of this Policy is to offer a helping hand to our employees who suffer from drug
and alcohol problems while clearly communicating that the abuse of drugs and alcohol will not
be tolerated. We are (have) contracting (contracted) with an employee assistance program to
help our employees and their families access the appropriate services to help them deal with drug
and alcohol problems. Employees experiencing drug and alcohol problems are encouraged to use
these services before these problems affect their employment status.
We are also developing a drug-testing program which includes substantial safeguards to protect
employee’s individual rights and to assure the accuracy and integrity of the program. All job
applicants will be tested and employees will be subject to reasonable suspicion, follow-up and
post treatment testing.
This Policy will take effect immediately, although employee drug testing will not be
implemented until (date 60-days later). (YOUR COMPANY) will also be implementing
employee drug education and awareness and supervisor training as part of its comprehensive
Drug-Free Workplace program.
It is important that we all work together to establish and maintain a work environment free from
the effects of drug and alcohol abuse.
President, (YOUR COMPANY)
Appendix C1. Drug-Free Workplace Policy (Small Business)
DRUG-FREE WORKPLACE POLICY
(YOUR COMPANY) is committed to ensuring a safe work environment and healthy, productive
employees. The company therefore prohibits: on-the-job use of illegal drugs or alcohol, coming
to work under the influence, and possessing or distributing drugs on company premises.
Violations of this Policy will result in disciplinary action up to and including discharge.
Employees are encouraged to seek assistance from community resources on a voluntary basis for
substance abuse related problems. Management may refer employees with drug problems to
specialists for assistance, however these employees will still be expected to correct behavioral
and performance problems which caused the referral. In handling suspected substance abuse
problems, managers’ and supervisors’ role is to document problems with performance and
behavior, informing employees that professional assistance for personal problems is available.
IF COMPANY HAS PRE-EMPLOYMENT DRUG TESTING:
All job applicants will be tested for illegal drugs as a condition of employment. Any applicant
who refuses to be tested or who has a confirmed positive test will be denied employment.
IF A COMPANY HAS AN EMPLOYEE ASSISTANCE PROGRAM:
The company offers an Employee Assistance Program (EAP) to employees and their dependents.
The EAP provides confidential assessment and referral for a range of personal problems,
including drug- and alcohol-related issues. Use of the EAP does not preclude an employee from
meeting job performance standards.
IF A COMPANY IS ALCOHOL FREE:
Use of alcohol at company functions, on company time, on company property, or during
breaks/lunch is prohibited.
IF A COMPANY CONDUCTS “REASONABLE CAUSE” DRUG TESTING:
It is a condition of employment that if requested, an employee submit to drug testing under the
following “reasonable cause” situations:
 When there are grounds for suspicion that an employee is under the influence of drugs or
alcohol.
 When there is a pattern of job performance and/or behavioral problems which supervisors
suspect may be caused by employee drug/alcohol abuse.
 When the employee has caused an accident on company property or while on company
business which resulted in personal injury requiring medical care or damage to property.
 As follow-up to treatment for alcohol/drug abuse, based on a random pattern established by
the authorized professional care provided.
 Refusal to be drug tested under these conditions will be handled the same as a positive test.
Appendix C2. Drug-Free Workplace Policy
DRUG-FREE WORKPLACE POLICY
It is the Policy of (YOUR COMPANY) that management shall take necessary measures to assure
that the use of alcohol or unauthorized substances by employees does not endanger the health,
safety and security of our employees, our operations, our customers or our site communities.
The unlawful manufacture, distribution, dispensation, possession, concealment, transportation,
sale or use of unauthorized substances on Company premises, in Company vehicles, or while
conducting Company business off Company premises is also strictly prohibited. Unauthorized
substances include illegal drugs, unauthorized drugs and drug paraphernalia. The abuse or
misuse of alcohol, prescription drugs or over-the-counter drugs which have been legally obtained
is also strictly prohibited on Company premises, in Company vehicles, or while conducting
Company business off Company premises.
The unauthorized possession or use of alcohol on or in any Company property or in Company
vehicles is also prohibited.
Violation of this Policy may lead to disciplinary action up to and including termination of
employment.
PRE-EMPLOYMENT SCREENING
(YOUR COMPANY) will require pre-employment substance screening of all applicants to
whom (YOUR COMPANY) will advise each applicant of the intent to test for substances and
require the applicant to permit the results of the test to be made available to management. If an
applicant does not wish to have screening tests performed, the pre-employment interview process
or examination will be terminated. If the applicant refuses the screening test or if the test
confirms the use of an unauthorized substance, the applicant will be disqualified from further
employment consideration for a minimum of twelve months.
EMPLOYEE TESTING
If there is reasonable suspicion of substance abuse or misuse, (YOUR COMPANY) may require
testing of current employees. Confirmed positive tests of urine blood or expired air, or refusal to
submit to testing or refusal of permission to release substance-testing information to appropriate
management, may be the basis of disciplinary action up to and including termination of
employment.
Substance testing is not a part of (YOUR COMPANY)’s ongoing occupational health evaluation
program.
RANDOM TESTING
Random substance testing may be instituted:
(1) For employees who have undergone or are undergoing treatment for substance abuse or
misuse;
(2) For employees in safety-sensitive or security-sensitive jobs;
(3) Where reasonable suspicion exists to warrant such testing; or
(4) Where necessary to comply with federal or state laws or regulations
INSPECTIONS AND SEARCHES
(YOUR COMPANY) has the right to require employees, while on duty or on Company premises
including parking lots, to agree to inspections of their clothing, vehicles, and/or their personal
property, as well as the offices, desk, and lockers assigned to them. If an employee withholds
consent to such an inspection, the Company may discipline the employee, up to and including
termination of employment.
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Employee rehabilitation is an important part of the Policy. Referral to the Employee Assistance
Program and/or approved alternative rehabilitation programs may be offered to employees. Such
referral will not necessarily prevent disciplinary action.
IMPLEMENTATION
It is the responsibility of the various sites to implement the Policy. While site programs may
vary depending upon local needs, each program should incorporate a balanced approach in the
areas of education, prevention, detection and rehabilitation.
Selection of quality controlled laboratories, standards and procedures for testing, chain of
custody, verification of test results, retention of specimens where applicable, confidentiality and
reporting of test results are the responsibilities of the (YOUR COMPANY) Medical Department
(may be contracted). Sites not having direct access to an ABC Medical Department and will be
assisted by the U.S. Area Medical Department in the selection of Department of Health and
Human Resources approved laboratories for substance abuse testing.
EMPLOYEES HANDLING GOVERNMENT CONTRACTS
Under federal law, employees working on government contracts are required, as a condition of
Company sales to or grants from the federal government, to notify the Company of any criminal
drug statute conviction for a violation occurring in the workplace no later than 5 days after such
conviction. Further, the law requires the Company to notify employees handling government
contracts that violation of the Company’s substance abuse Policy may lead to disciplinary action
up to and including termination of employment.
LAWS OR REGULATIONS AFFECTING SPECIFIC EMPLOYEES
If federal or state laws or regulations are promulgated which pertain to and affect specific groups
of employees, those employees will be informed of any necessary changes or additions to this
Policy applicable to them by means of special separate supplements to this Policy.
Appendix C3. Drug-Free Workplace Policy
DRUG-FREE WORKPLACE POLICY
(YOUR COMPANY) supports the Federal Drug-Free Workplace Law
It is the Policy of (YOUR COMPANY) to maintain a safe work environment conductive to
effective business operations.
Employees are expected and required to report to work on time and in appropriate mental and
physical condition for work. It is our intent and obligation to provide a drug-free, healthful, safe
and secure work environment.
The unlawful manufacture, distribution, dispensation, use, possession, or being under the
influence of alcohol, any illegal substance or any controlled substance, without proper verifiable
medical authorization, on Company premises or while conducting Company business off
Company premises is absolutely prohibited. Possession of paraphernalia used in connection with
any drug or substance subject to this Policy shall be evidence of violation of this Policy.
Violation of this Policy will result in disciplinary action, up to and including immediate
discharge, and may have legal consequences. Any sale of illegal drugs during the work day or in
the Company premises will be treated as gross misconduct punishable by immediate discharge
for the first offense. Any employee who is arrested for selling drugs while off duty will be
discharged if convicted of a criminal offense.
The Company reserves the right to require employees to submit to a drug and/or alcohol test
when, in the Company’s sole discretion, employees appear to be in an impaired condition on the
job, when employees are involved in an on-the-job accident or injury, or under other similar
circumstances. The types of tests that may be used may include breathalyzer tests, blood tests
and urinalysis. A positive test will result in disciplinary action, up to and including immediate
discharge, and may have legal consequences. Refusal to submit to the test will result in
immediate termination. The Company will make appropriate arrangements for the employee’s
travel to the location of the test.
All employees who must use a prescription drug that causes adverse side effects (e.g., drowsiness
or reflexes or reaction time) should inform their Supervisor or Shift/Group Leader and provide
doctor advice on the possible effects of the drug on performance and expected duration of use. If
there are possible production or safety problems, the Shift/Group Leader will temporarily assign
the worker duties consistent with the doctor’s advice.
The Company recognizes drug and alcohol dependency as an illness and a major health problem.
The Company also recognizes drug and alcohol abuse as a potential health, safety and security
problem. Employees needing help in dealing with such problems are encouraged to use
community assistance programs as appropriate. Confidential information about seeking help
from such programs can be obtained from the Human Resource Manager. Conscientious efforts
to seek such help will not jeopardize any employee’s job and will not be noted in any personnel
record.
Pre employment drug screening will be performed on all applicants considered for employment
at (YOUR COMPANY) believes the pre-employment screening is an effective way to identify
potential employment risks and prevent them from entering our work force.
Employees must, as a condition of employment, abide by the terms of the above Policy.
Appendix C4. Drug-Free Workplace Policy
DRUG-FREE WORKPLACE POLICY
This constitutes the Policy of (YOUR COMPANY) on controlled substances, illegal drugs, and
alcohol. This Policy is issued in conjunction with (YOUR COMPANY)’s commitment to
maintain a drug and alcohol free workplace. As used in this Policy, “controlled substances” and
“illegal drugs” broadly refer to all forms of narcotics, depressants, stimulants, hallucinogens and
other drugs, including marijuana, whose use, possession or transfer is restricted or prohibited by
law (except the use of possession of drugs prescribed by a physician or dentist).
1. Employees are prohibited from engaging in any of the following activities while on Company
premises, on Company work sites (including Company vehicles and any private vehicle
parked on Company owned or leased premises or work sites), or while on Company business:
a. The illegal possession, distribution, manufacture, transportation, use, sale, purchase, or
transfer of controlled substances or illegal drugs.
b.
The illegal possession, distribution, manufacture, transportation, use, sale, purchase,
transfer, or consumption of any type of alcoholic beverages. The only exceptions are the
consumption of any type of alcoholic beverages served at Company - sponsored events or at
authorized business meetings or when the beverage is in the manufacturer’s container and
the manufacturer’s seal has not been broken.
c. Being at work under the influence of alcohol, drugs, or controlled substances, regardless of
whether they were consumed during, or out of, work time. “Under the influence” is defined
as being unable to perform work in a safe and productive manner; and being in a physical
or mental condition which creates a risk to the safety and well-being of the individual, other
employees, the public, or Company property.
Employees who engage in the above-stated activities in violation of this Policy will be
subject to criminal prosecution (where applicable) and disciplinary action up to and
including dismissal (and, in appropriate circumstances, dismissal for a first offense).
2. Employees who engage in any of the following activities while off Company premises or off
Company worksites and/or off working time will also be subject to disciplinary action up to
and including dismissal:
a. The illegal possession, distribution, manufacture, transportation use, sale, purchase, or
transfer of controlled substances or illegal drugs - where such involvement constitutes a
direct threat to Company property or Company employees, or affects an employee’s job
performance, or generates either publicity or circumstances which adversely affect the
Company or its employees; or
b. The felonious possession, distribution, manufacture, transportation, use, sale or purchase of
illegal drugs or controlled substances.
3. As a condition of employment, employees will:
a. Abide by the terms of this Policy; and
b. Notify the Company of any criminal drug statute conviction for a violation occurring in the
workplace no later than five (5) days after such conviction.
4. Employees who violate this Policy on Drug and Alcohol Abuse and/or are convicted of a drug
or alcohol offense may be required, in some instances, to participate in the Employee
Assistance program (EAP), a service of the medical organization, and/or satisfactorily
complete a rehabilitation program as a condition of continued employment.
5. Employees who have medical/ behavioral problems related to controlled substance, illegal
drug and/or alcohol abuse are encouraged to avail themselves of the EAP. EAP is not a
disciplinary program but is designed to motivate and assist employees to resolve their problems
and improve job performance. This program ensures that any counseling or treatment
recommended through the EAP will be conducted in a private and confidential manner, to the
extent practicable, and that any associated medical records will be held in strict confidence.
Appendix C5. Drug-Free Workplace Policy
DRUG-FREE WORKPLACE POLICY
1. Introduction
1.1 It is our Policy to provide a safe place to work and to establish programs promoting
high standards of employee health.
1.2 It is the firm belief of the management and ownership of (YOUR COMPANY) that it
is in the best interest of each employee’s health, safety, and well being that every attempt
be made to assure that there are not drugs or alcohol on authorized and illegal substances
either refrain from such use or no longer be a part of the company. (YOUR COMPANY)
is willing and anxious to help any employee with a substance abuse problem in order to
allow that person to remain with the company. Unfortunately, not every employee is
willing to be helped. In these cases, employment will be terminated.
2. Definitions
2.1 Unauthorized Drug - Any drug that cannot be obtained legally or has been illegally
obtained, including prescription drugs obtained without a prescription, prescribed or over
the counter drugs used other than as properly instructed and drugs represented as being
illegal.
2.2 Authorized Drug - Prescribed drugs that are used as prescribed by a medical
professional or over the counter drugs used as intended by the manufacturer.
2.3 Under the Influence - For the purpose of this Policy, that the employee is affected by
an unauthorized drug or alcohol in any detectable amount (this detectable level can be
altered in your Policy to reflect acceptable threshold levels).
2.4 EAP - The Company’s designated Employee Assistance Program which is available
to provide assessment, referral and counseling on a confidential basis.
2.5 Policy Coordinator - The individual designated by the Company President to
administer the requirements of this Policy
2.6 Pre-Termination Meeting - A meeting established to deal with any employee who has
been placed on suspension with the intention of termination because the employee has
failed to comply with this Policy. The suspended employee will be allowed to meet with
at least two management employees, one of whom must be the Policy Coordinator. This
meeting will determine if there are any extenuating circumstances which would allow
reconsideration of the termination decision.
2.7 Benefits - Only (YOUR COMPANY) employees and dependents who are covered by
our current health benefit plan are eligible for chemical dependency treatment benefit
coverage. Employees who are covered under other benefit plans will be covered under
the same coordination of benefits Policy as authorized by this current health benefit plan.
3. Scope This Policy covers all applicants to and employees of (YOUR COMPANY)
4. Possession
4.1 Pre-Employment - Every candidate for a job at (YOUR COMPANY) will be required
to report to a local testing facility and provide the required specimens for analysis. If the
test results are positive for unauthorized drugs, the individual will be denied employment
and informed as to the reason.
4.2 Post-Employment - The company may direct at anytime that every employee or a
randomly selected group of employees of the company submit to a drug and alcohol
screening test. This will occur at an unannounced time and take place on the company
property by an approved testing company.
4.2.2 An accurate account will be kept of those employees who have been tested
and those who have not due to absence or other reason.
4.2.3 Any employee who misses this required testing will be contacted at home or
as soon as he or she returns to work will be informed that he/she must report to
the local testing facility within 24 hours of being so informed to have the required
screening performed.
4.2.4 Any employee who misses this required testing will be contacted at home or
as soon as he or she returns to work. The employee will then be informed that
he/she must report to the local testing facility within 24 hours of being so
informed to have the required screening performed.
4.3 For Cause - Any employee who reports to work and based on the observation of at
least two responsible individuals appears to be under the influence of alcohol or an
unauthorized drug, will be asked to leave the premises.
4.3.1 If necessary, a family member will be contacted to escort the employee
home or another employee will do the same to insure the safe transportation of the
employee.
4.3.2 In these cases, the employee will be immediately directed to take an alcohol
and drug screening test to determine if unauthorized drugs or alcohol was the
cause of the problem, or if another medical problem may exist.
4.3.3 Any employee who is involved in an on-the-job accident may be directed to
take a drug and alcohol screening test before returning to work if in the view of
management, drugs or alcohol may have been a contributing factor. This applies
to accidents whether or not injury or property damage is involved.
4.4 Post-Rehabilitation - If an employee has successfully completed a rehabilitation
program, the Policy coordinator may direct the individual to report for a drug and alcohol
screening test without notice.
4.4.1 If the test is positive, the employee will be suspended with the intention to
terminate pending a Pre-Termination Meeting.
5. Reporting of Results
5.1 Any employee who has been required to take a drug and alcohol screening test will
be informed of the results.
5.2 The results will be given to the Employee Assistance program administrator who
will notify the employee by sending the results to the employee’s home address.
5.3 If the test is positive, the employee will be suspended with the intention to terminate
pending a Pre-Termination Meeting.
6. Employee Requirement Employees must disclose any conviction for a drug related offense
in the workplace to (YOUR COMPANY) within 5 days after such conviction. Failure to comply
with this Policy will result in disciplinary action up to and including discharge..
7. Employee Requirements Pending a Positive Test Result
7.1 The following steps must be taken by any employee who is found to be under the
influence of either alcohol or unauthorized drugs following a screening in accordance
with this Policy.
7.1.1 Any employee who has a positive test will be contacted by the EAP
administrator to setup an assessment appointment at an early date.
7.1.1.1 Any employee who fails to set up or keep an appointment will be
placed on suspension with the intention to terminate pending a PreTermination Meeting
7.1.2 After one or several meetings with a qualified counselor for the EAP, a
course of treatment may be recommended by the EAP counselor.
7.1.2.1 The EAP counselor will be responsible to follow the progress of
the treatment.
7.1.2.2 If the employee fails to continue the program of treatment agreed
upon, the Policy Coordinator will be informed of the situation and the
employee will be placed on suspension with the intention to terminate
pending a Pre-Termination Meeting.
8. Searches (YOUR COMPANY) reserves the right to search employees, visitors, lockers,
personal effects, cars and work areas. The company does not intend to implement such searches
in an arbitrary or indiscriminate manner.
9. Employee Assistance Program (EAP)
9.1 Employees are encouraged to request assistance through the EAP. Participation will
be confidential.
9.2 Participation in the EAP does not relieve the employee from job expectation
requirements.
10. Confidentiality
10.1 All information involving medical examinations, drug or alcohol test results or
treatment procedures will be treated as confidential information and will be accessible
only to those company officials and designated medical and professional persons with a
specific need to know.
10.2 Drug/Alcohol test results or treatment procedure information will not be provided to
any other party without the written consent of the employee, except as required by state or
federal laws.
Appendix D. Drug-Free Workplace Policy Acknowledgment Form
DRUG-FREE WORKPLACE POLICY ACKNOWLEDGMENT FORM
I acknowledge that I have received a copy of the Drug-Free Workplace Policy and procedure and
that I have read and understand this document.
I further understand that this Policy supersedes and replaces all prior policies, handbooks, or
other publications related to these personnel matters.
I understand that if I refuse to consent to drug and alcohol screening, or if I test positive and fail
to meet my obligation under the Drug-Free Workplace Program, I will be subject to disciplinary
action, including termination of employment.
____________________________________
Employee’s Signature
___________________________________
Date
____________________________________
Employee’s Name (printed)
_____________________________________
Witness
___________________________________
Date
Appendix E. Last Chance Agreement
LAST CHANCE AGREEMENT
I, ________________________________, understand that my (reinstatement and) continued
employment (are) is contingent upon compliance with all of the following terms of this
agreement.
.
I will be evaluated of chemical dependency by the company’s
employee assistance program (EAP).
.
I will comply with all of the EAP treatment and follow-up
recommendations.
.
I authorize the company to receive all relevant information
regarding my progress in my rehabilitation program.
.
I will be subject to unannounced testing (follow-up monitoring) for
up to two years.
.
I recognize, accept, and agree that any future violation of the
company’s drug-free workplace Policy by me will result in the
termination of my employment.
.
I am responsible for meeting the same standards of performance and
conduct that are set for other employees.
I understand that failure to comply, in whole or in part, with all of the terms and conditions of
this agreement will result in further disciplinary action, up to and including termination of
employment with the (YOUR COMPANY).
______________________________________________________________________________
Employee Signature
Date
______________________________________________________________________________
Company Representative
Date
Appendix F. Where to Find Help
NATIONAL HOTLINES
If you or someone you know has a problem with alcohol or other drugs, call these hotlines for
free, confidential help.
The Center for Substance Abuse
Treatment’s (CSAT) Drug
Information, Treatment, and
Referral Hotline:
1-800-662-HELP
1-800-66-AYUDA (Spanish)
Families Anonymous
1-800-736-9805
Center for Disease Control’s
(CDC) National HIV/AIDS
Hotline
1-800-342-2437
Nar Anon
1-800-333-1069
Parents Resource Institute for
Drug-Free Education (PRIDE)
(404) 577-4500
Toughlove
1-800-333-1069
PUBLICATIONS
The following list of readings can be ordered for free by calling the National Clearinghouse for
Alcohol and Drug Information at 1-800-729-6686:





Growing Up Drug Free: A Parent’s Guide to Prevention
Helping Your Child To Say No To Alcohol And Other Drugs (Bilingual)
Alcoholism Tends To Run In Families
What You Can Do About Drug Use In America (Bilingual)
How Getting High Can Get You AIDS
Ask for the telephone number of your State clearinghouse - the RADAR Network - from the
National Clearinghouse for Alcohol and Drug Information
More Information about alcohol and other drug abuse can be ordered for a fee from these
publishers:




Hazelden Educational Materials:
Health Communications:
Parkside Publishing:
Performance Resource Press:
Also check your local library or bookstore.
1-800-328-9000
1-800-851-9100
1-800-221-6364
1-800-453-7733
LOCAL RESOURCES
Look in your local telephone book for these numbers:
Alcoholics Anonymous
_____________________________
Alateen (for children of the user
_____________________________
Al-Anon (for family members and friends)
_____________________________
Adult Children of Alcoholics (ACOAs)
_____________________________
Nar-Anon (for family members and friends)
_____________________________
Drug Treatment Center
_____________________________
Cancer Society
_____________________________
Lung Association
_____________________________
County or State Addiction or Mental Health Agency
_____________________________
County/Victim/Mental health Hotline
_____________________________
Other
_____________________________