DRUG AND ALCOHOL POLICY EMPLOYEE ACKNOWLEDGEMENT FORM
I hereby acknowledge that the Company's Drug and Alcohol Policy has been reviewed and explained to me and that the Company has presented and I have attended a Substance Abuse Education Program on the topics listed below.
I further acknowledge receipt of educational materials which discuss in detail the following topics:
1. The designated person to answer question about the materials.
2. The categories of employees subject to the company’s DOT Substance Abuse Policy.
3. Sufficient information about the safety-sensitive functions and periods of the workday that compliance is required.
4. Specific information concerning prohibited employee conduct.
5. Circumstances under which an employee will be tested.
6. Test procedures, employee protection and integrity of the testing processes, and safeguarding the validity of the test.
7. The requirement that tests be administered in accordance with DOT regulations.
8. An explanation of what will be considered a refusal to submit to a test and the consequences.
9. The consequences for Part 382 Subpart B violations including removal from safety-sensitive functions and §382.605 procedures.
10. The consequences for covered employees found to have an alcohol concentration of 0.02 or greater but less than 0.04.
11. Information on the affects of alcohol and controlled substances use on:
• An individual’s health
• Work
• Personal life
• Signs & symptoms of a problem
• Available methods of intervening when a problem is suspected
I further agree that as a condition of continued employment, I will abide by the Company’s Drug and Alcohol Policy, including the provision for random testing of all employees.
I agree that, as an employee, if I refuse to submit to any drug test or if I fail an alcohol and/or drug test, I will be removed from the job and referred to rehabilitation or employee assistance at my own expense. Any refusal to be referred to rehabilitation will result in immediate termination.
Also, I agree that if convicted of a violation of a criminal drug statute in the workplace, I will notify the Company within five (5) days of the conviction.
I acknowledge and consent freely and voluntarily to the Company’s right to conduct unannounced searches for illegal drugs and alcohol on Company property, in its facilities and vehicles on job sites. I understand that the Company has the right to inspect: company lockers, desks, work areas, vehicles and other containers and objects on Company property that might conceal illegal drugs/alcohol.
I further acknowledge and consent freely and voluntarily to reasonable searches of my person and my personal property. I understand ta failure to cooperate fully with the Company in this regard will result I disciplinary action including possible termination.
I understand and agree to the above terms and conditions of employment. I understand that the above in no way creates an obligation or contract of employment and that I, as well as the Company, have the right to end the employment relationship at any time.