Substance Abuse Program

Substance Abuse Program

(“COMPANY NAME”)

Substance Abuse Program

Effective 00/00/0000

NOTE:

This sample policy is to be used as a guideline for a Company’s custom policy. It is recommended that any policy be reviewed by legal counsel prior to implementation.

Table of Contents

I.Purpose3

II.Statement of Policy3

III.Employee Responsibilities3

IV.Penalties3

V.Definitions4

VI.Drug Testing Procedures4-5

VII.Confidentiality5

VIII.Use of Controlled Substances5

App. I.Consent and Release of Liability for Drug Testing6

App. II.Drug Testing Resources7

App. IIIReasonable Suspicion Drug Testing Checklist8-9
App. IVInitial Notice to Employee-Applicant of Drug Test10

App. VPost-Test Notice to Employee-Applicant of Drug Test11

  1. Purpose:

(“COMPANY NAME”) has a vital interest in maintaining a safe, healthy and efficient workplace for the benefit of its employees, clients and the public. The use of performance impairing drugs can cause avoidable injuries to employees, damage to property and productivity losses.

  1. Statement of Policy:

To ensure a safe and productive work environment, employees are prohibited from:

  1. Unlawfully manufacturing, distributing, dispensing, possessing, misusing or abusing or controlled substances, as defined by the Drug Enforcement Agency.
  1. The use of any illegal drugs
  1. Violating any Federal or State law relating to drugs.
  1. The exception to this policy is the authorized possession, use and transportation of drugs prescribed by a Physician (“controlled substances”) and used according to prescription instructions, unless such use would pose a safety risk to the employee, other employees or the public.
  1. Employee Responsibilities:

As a condition of employment, each employee must:

  1. Abide by this Substance Abuse Policy and
  1. Notify (“COMPANY NAME”) of any criminal drugs statute conviction for a violation of Federal or State law relating to drug use, possession or dealing no later than five (5) days after such conviction.
  1. Employees who are required to submit to Post-Accident Drug Testing agree to accept, at (“COMPANY NAME”) discretion, transportation to a location where the test will be conducted or, if legally allowed, to provide an oral saliva sample for drug screening purposes.
  1. Penalties:

Any employee who violates this Substance Abuse Policy shall be subject to discipline up to and including termination. Nothing in this Policy changes the at-will employment relationship and employees may be terminated at any time with or without cause or notice.

  1. Definitions:

DRUG:Any substance that has known mind, mood, or function-altering effects on a person, including substances prohibited or controlled by Federal or State controlled substance law.

CONTROLLED

SUBSTANCE:Any prescribed medication that has the potential for abuse and dependence.

SAMPLE:Oral fluid, urine, hair or blood.

  1. Drug Testing Procedures:

Pre-employment Testing

  1. Each applicant for a position with (“COMPANY NAME”) will be subject to the Company’s Substance Abuse Program.
  1. All offers of employment to applicants will be contingent upon the applicant passing a drug test in accordance with this Substance Abuse Policy.
  1. An applicant who refuses to submit to pre-employment testing when requested, or refuses to sign the Company’s Consent and Release of Liability for Drug Testing form, will not be employed by (“COMPANY NAME”).
  1. If an applicant’s test is positive for any illegal drug, the applicant will not be employed by (“COMPANY NAME”). Applicants’ samples that test positive for controlled substances will be reviewed by a Medical Review Officer (MRO) to determine if the applicant is taking said substance in accordance with the prescribing physician’s orders. The MRO’s evaluation will determine if an applicant is or is not hired.

Random/Periodic Testing

  1. (“COMPANY NAME”), at its discretion, may institute a program of random testing of current employees. This program may include testing of all personnel at a job site or a random selection program of individuals throughout the year.
  1. If selected for a random test, the employee must go immediately to the collection area and submit a sample for drug testing.
  1. Refusal to submit a sample or to properly complete documentation for a random test will be considered a refusal to test, which will require discipline up to and including termination.

Reasonable Suspicion Testing

  1. When (“COMPANY NAME”) has a reasonable suspicion that an employee may be under the influence of a substance a drug test may be conducted immediately. “Reasonable suspicion” will be documented, using the criteria listed in Appendix III.
  1. Employees suspected of being unfit for duty will be escorted by a supervisor or designated Company representative to the authorized testing location. The employee’s cooperation with the escort and the collection procedures will be required.
  1. Refusal to cooperate in the collection procedure or refusal to take the test will require discipline up to and including termination.

Post-Accident Drug Testing

  1. (“COMPANY NAME”) will conduct Post-Accident Drug Testing (PADT), unless the immediate known facts of the accident indicate that impairment of the injured worker could not have played a role in the accident occurring. Nevertheless, if Federal or State law or regulations require specific post-accident testing, (“COMPANY NAME”) will conduct PADT within compliance of said law or regulation, regardless of the facts surrounding the accident.
  1. Refusal to cooperate in the collection procedure or refusal to take the test will require discipline up to and including termination.
  1. Confidentiality:

Only those persons authorized to receive results from the laboratory will be allowed to discuss these results with the supervisor or the employee.

No test results shall appear in a personnel folder. Information of this nature will be included in a medical file.

Drug test results will be released to a decision maker in a lawsuit, grievance or other proceeding (such as for a Workers’ Compensation or Unemployment Insurance Claim) initiated by or on behalf of the donor.

  1. Use of Controlled Substances:

In the event an employee is under the care of a physician and is taking any prescribed medication that is classified as a controlled substance (which might impair their ability to perform a job safely), the employee must notify management in advance of starting work. It is at management’s discretion as to whether the employee may continue to perform the normal assigned duties or be designated non-safety sensitive duties (if available) until the employee provides a physician release to perform normal duties.

Appendix I

Consent and Release of Liability for Drug Testing

I understand that as a condition of employment with (“COMPANY NAME”), I may be required to submit a sample of my oral fluid and/or urine for chemical analysis as outlined in the “Drug Testing Procedures” listed above. I understand that the collection of this sample may or may not be collected by my employer and that the analysis will be conducted by a certified laboratory. The purpose of this analysis is to check for the presence of substances of abuse, including (but not limited): amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine, marijuana (THC), methadone, methamphetamines, opiates, oxycodone, phencyclidine (PCP), and alcohol. In the event that the above substances are not available to be tested, the panel of drugs to be tested will be determined by the collection facility.

I hereby give permission for any certified laboratory to release the results of these tests to (“COMPANY NAME”). I consent freely and voluntarily to this request for oral fluid and/or urine specimen. I hereby release (“COMPANY NAME”) from any liability arising from this request to furnish oral fluid and/or urine samples, the testing of the oral fluid and/or urine samples and any decision made concerning my application for employment or ongoing employment which may be based in whole or in part upon the result of the test analysis. I also understand that if it is determined that the use of an illegal drug was the proximate cause of a workplace accident, that my Workers’ Compensation claim may be denied.

I understand that the presence of any illegal drug/alcohol or abused controlled substances in my system may result in the denial of employment with (“COMPANY NAME”) or the termination of that employment. Additionally, I understand that the presence of any controlled substance in my system will require that a Medical Review Officer at a certified laboratory review the results to ensure that I have a valid prescription for the substance, and that I am taking the medication as prescribed by my treating physician. I understand that if both of the latter two conditions are not met by the Medical Review Officer that it may result in the denial of employment with (“COMPANY NAME”) or the termination of that employment. I further understand that employment with (“COMPANY NAME”) may be conditioned upon my willingness to submit to and the results of periodic drug and/or alcohol testing required by the Company. Likewise, I understand that refusal to submit to or cooperate with any such testing may result in termination of my employment.

Date: ______

(Signature of Applicant/Employee)

Appendix II

Drug Testing Resources

General Drug Testing Information:

 National Institute on Drug Abuse:

http://www.nida.nih.gov/

 Office of National Drug Control Policy:

http://www.whitehousedrugpolicy.gov/prevent/workplace/demog.html

 U.S. National Library of Medicine:

http://www.nlm.nih.gov/medlineplus/drugabuse.html

 U.S. Department of Labor:

http://www.dol.gov/workingpartners/welcome.html

 National Drug-Free Workplace Alliance:

(Homepage)

(Workplace Drug Use Statistics)

Certified Testing Laboratories:

Your chosen medical provider will most likely have established relationships with certified testing laboratories. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a list of certified testing laboratories by state:
http://www.samhsa.gov/sites/default/files/workplace/state-certified-labs-list-february-2016.pdf

Appendix III

Reasonable Suspicion Drug Testing -- Documentation Checklist

Behavioral:

Unsteady gait/stumbling?

☐Yes☐No

Drowsy, sleepy, lethargic?

☐Yes☐No

Agitated, anxious, restless?

☐Yes☐No

Hostile, belligerent?

☐Yes☐No

Irritable, moody?

☐Yes☐No

Depressed, withdrawn?

☐Yes☐No

Clumsy, uncoordinated?

☐Yes☐No

Tremors, shakes?

☐Yes☐No

Suspicious, paranoid?

☐Yes☐No

Hyperactive, fidgety?

☐Yes☐No

Inappropriate, uninhibited behavior?

☐Yes☐No

Frequent use of mints, mouthwash, eye drops?

☐Yes☐No

Appearance:

Flushed complexion?

☐Yes☐No

Excessive sweating?

☐Yes☐No

Bloodshot eyes?

☐Yes☐No

Tearing/watering eyes?

☐Yes☐No

Dilated (large) pupils?

☐Yes☐No

Constricted (pinpoint) pupils?

☐Yes☐No

Unfocused, blank stare?

☐Yes☐No

Disheveled clothing/unkempt appearance?

☐Yes☐No

Speech:

Slurred or thick?

☐Yes☐No

Incoherent?

☐Yes☐No

Exaggerated enunciation?

☐Yes☐No

Loud, boisterous?

☐Yes☐No

Rapid, pressured?

☐Yes☐No

Excessively talkative?

☐Yes☐No

Nonsensical?

☐Yes☐No

Cursing, inappropriate speech?

☐Yes☐No

Other observations: ______

Describe in detail any “Yes” responses: ______

Supervisor/Manager signature: ______Date: ______

Witness signature: ______Date: ______

TEST DETERMINATION

☐ Drug test required

☐ Employee agreed to drug test
☐ Employee refused drug test

☐ No drug test required

Appendix IV

[COMPANY NAME]

N.C. CONTROLLED SUBSTANCE EXAMINATION REGULATION ACT

INITIAL NOTICE TO EMPLOYEES/APPLICANTS

In accordance with our company policy, you have been selected for a _____ controlled substance test (specify '"post-accident," "'random,'' etc.). In accordance with 13 NCAC 20.0401, this Notice explains your rights and responsibilities under the N.C. Controlled Substance Examination Regulation Act ("CSERA") (Chapter 95, Article 20 of the N.C. General Statutes) and the corresponding administrative rules (Title 13, Chapter 20 of the N.C. Administrative Code).

  • You may refuse this test; however, your job or employment opportunity may be in jeopardy.
  • Although applicants may be screened by means of a "Quick Test," any positive results must be confirmed by an approved lab using gas chromatography with mass spectrometry (GS/MS) or equivalent scientifically accepted method before hiring decisions are made.
  • Current employees cannot be screened by means of a "Quick Test''
  • An approved laboratory must perform testing of samples.
  • You can request a "re-test" of any positive sample. Retests must be of the same sample and must be paid for by the employee.
  • You can file a complaint with the N.C. Department of Labor - Wage and Hour Bureau at (919) 807-2796 or 1-800-NC-LABOR if you believe procedural requirements of the CSERA were violated. The Department has no jurisdiction regarding an employer's requirement for controlled substance testing or its decisions regarding results of controlled substance testing.

Employee/ApplicantDate

Employer RepresentativeTitle

Disclaimer: The foregoing information is presented solely for the convenience of the reader and is not intended to replace any official source. Under no circumstances shall the Department of Labor be liable for any actions taken or omissions made from reliance on any information contained herein.

Appendix V

C O N F I D E N T I A L

[COMPANY NAME]

N.C. CONTROLLED SUBSTANCE EXAMINATION REGULATION ACT
POST-TEST NOTICE TO EMPLOYEES/APPLICANTS

The sample you provided on , as required by our company policy and the N.C. Controlled Substance Examination Regulation Act ("CSERA"), has tested positive for

We were notified of this positive result on ______. In accordance with 13 NCAC 20.0402, this Notice explains your rights and responsibilities under the CSERA (Chapter 95, Article 20 of the N.C. General Statutes) and the corresponding administrative rules (Title 13, Chapter 20 of the N.C. Administrative Code).

  • You must be given written notice of any positive result of a controlled substance examination within thirty (30) days of employer notification of the positive result.
  • You must be given a copy of this Notice or other written notice of your rights and responsibilities regarding re-testing.
  • You may request, in writing, a re-test of the above sample at the same or other approved laboratory within ninety (90) days of the date you are notified of the result. You must pay all expenses associated with the re-test.
  • Results of controlled substance examinations, medical histories and use of lawful prescription drugs must be kept confidential by the employer.
  • You can file a complaint with the N.C. Department of Labor - Wage and Hour Bureau at (919) 807-2796 or 1-800-NC-LABOR if you believe procedural requirements of the CSERA were violated. The Department has no jurisdiction regarding an employer's requirement for controlled substance testing or its decisions regarding results of controlled substance testing.

Employee/ApplicantDate

Employer RepresentativeTitle

Disclaimer: The foregoing information is presented solely for the convenience of the reader and is not intended to replace any official source. Under no circumstances shall the Department of Labor be liable for any actions taken or omissions made from reliance on any information contained herein.