Notice of Drug-Screening Failure

Notice of Drug-Screening Failure

Date: FILL IN DATE

It is Nextran Corporation’s policy to provide employees with the opportunity for treatment in the event that an employee fails drug testing during the scope of his or her employment. Results of random drug testing on ENTER DATEindicated your failure to remain drug-free. Because Nextran Corporation values our employees, we provide this option for rehabilitation rather than immediate termination; however, we have set forth the following guidelines for such rehabilitation processes to ensure that all employees are treated equally under such circumstances.

In order to remain employed with Nextran Corporation, you are required to attend rehabilitation at you own cost. If you are a DOT employee, you will be required to contact a substance abuse professional (SAP) for evaluation and treatment. A list of acceptable SAPs will be provided to you. If you are enrolled in company-sponsored benefits, you may contact the 1-800 number on your insurance card for guidance on in-network rehabilitation programs and/or to inquire as to whether or not a SAP is covered. Or, you may look in your local phone book for such programs. If you are not interested in pursuing the rehabilitation option, you will be considered to have terminated voluntarily from Nextran Corporation.

It is your responsibility to show that you have enrolled in such a program by 15 DAYS AFTER DATE OF NOTICE IN HEADING – ADD DATE. If this date falls on a Saturday or Sunday, you must provide such documentation by the Monday immediately following the fifteenth day. Such documentation must indicate the intended date of completion for such rehabilitation program. Until such documentation is received, you will remain suspended without pay (within the provisions under the Fair Labor Standard Act). Once such documentation is received, we will discuss reasonable accommodations for your job while going through rehabilitation. (Reasonable accommodations may include leave without pay if on-the-job accommodations provide an undue hardship to Nextran Corporation.) DOT employees are not permitted to perform work in “safety-sensitive” positions until completion of rehabilitation and testing as designated by a Substance Abuse Professional.

Upon completion of your rehabilitation, you must provide certification to Nextran Corporation within two (2) business days. Upon receipt of completion, you will be asked to submit to a return-to-duty drug screen at Nextran Corporation’s expense.

Failure to follow the guidelines set forth may result in your termination of employment.

After your completion of rehabilitation, Nextran Corporation can test you at random. Current DOT regulations require six (6) tests to be performed during the first twelve (12) month period after your return-to-work. These drug screens will be at Nextran Corporation’s expense. Failure to pass such subsequent drug screens may result in immediate termination from employment.

Please sign below and return this form to your local coordinator to signify that you understand and agree with the terms and conditions set forth for your continued employment with Nextran Corporation.

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Print Name Company Representative’s Name

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Employee Signature / DateRep’s Signature/Date

Please Note: Nextran Corporation reserves the right to change any policy or procedure at any time. State and/or federal law changes/updates will prevail over the language specified in this document.