APPENDIX A
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Acknowledgment
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This will certify that I, ____________________,
have been given a copy of the City of Long Branch's Public Works Department
Policy addressing alcohol and drugs in the workplace, and that I fully
understand said policy and agree to comply with all terms and requirements
set forth herein.
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EMPLOYEE
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___________________________________
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DATE
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___________________________________
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WITNESS
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___________________________________
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DATE
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___________________________________
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APPENDIX B
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Donor's Checklist for Drug Testing
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The collection of your urine
will be conducted under procedures mandated by the Department of Transportation.
The DOT regulations provide for your individual privacy unless there
is reason to believe that you may have altered or substituted the
urine specimen.
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Please take a few minutes
to read the following information, which describes your role in the
collection process.
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Present required photo identification
to the collector. If you do not have a photo ID, an employer representative
will be asked to identify you.
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You may ask the collector
to show his/her identification.
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Remove any unnecessary outer
garments, e.g., coat, jacket. All personal belongings (e. g., purse,
briefcase) must remain with outer garments. You may ask for a receipt.
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When instructed by collector,
wash and dry your hands.
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You will be provided a sealed
specimen bottle or collection container, or the collector may unwrap
it in your presence. You will be allowed to select your specimen kit
from a box full of like, sealed specimen kits.
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You may provide the specimen
in the privacy of a stall or otherwise partitioned area that allows
for individual privacy.
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After providing the specimen
to the collector, he/she will divide the sample into two separate
bottles.
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You should initial the security
tape on the specimen bottles to certify that it is your specimen.
These sealed bottles will then be placed in a security bag or security
box. These will be sealed with security tape in your presence.
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You should observe the entire
collection procedure.
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You should complete the information
on copies 3 through 6 of the custody and control form. You will be
given a copy of the completed form after the collector has completed
his/her certification.
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You should NOT list medications/prescriptions
on any other copy of the form except the copy which you are given
for your records.
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The results of the laboratory
analysis will be forwarded to our Medical Review Officer. If the laboratory
results are negative, the MRO will notify your employer. If the laboratory
results are positive, the MRO will contact you at the phone number
you provided to give you the opportunity to discuss the test results.
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APPENDIX C
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Prohibited Conduct
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The following conduct is specifically
prohibited by law:
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A.
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Alcohol concentration.
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(1)
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No employee shall report for duty or remain
on duty while having an alcohol concentration of 0.04% or greater,
and no employer having actual knowledge that an employee has a concentration
of 0.04% or greater shall permit an employee to perform or continue
his/her duties.
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(2)
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An 0.02 or greater means no functions can be
performed for 24 hours and another negative screen is revealed to
the employee's supervisor.
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B.
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Alcohol possession. No employee shall be on
duty or operate a motor vehicle while on duty with the City while
possessing alcohol, unless the alcohol is manifested and transported
as part of the shipment. No employer having actual knowledge that
the employee possesses alcohol may permit the employee to drive or
continue to drive a motor vehicle.
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C.
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On-duty alcohol use. No employee shall use alcohol
while performing his/her duties, and no employer having actual knowledge
that an employee is using alcohol shall permit the employee to perform
or continue to perform his/her duties.
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D.
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Pre-duty alcohol use. No employee shall perform
his/her duties within four hours after using alcohol if such use impairs
the employee's duties, and no employer, having actual knowledge that
an employee has used alcohol within the preceding four hours, shall
permit an employee to perform or continue to perform his/her duties
if such use impairs the employee's duties.
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E.
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Alcohol use following an accident. No employee,
who is subject to a post-accident alcohol test, shall use alcohol
for eight hours following the accident or until he or she undergoes
a post-accident alcohol test, whichever occurs first.
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F.
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Refusal to submit to a required alcohol or controlled
substance test. No employee shall refuse to submit to an alcohol or
controlled substance test under any circumstances in which the City
rules require such a test. No employer shall permit an employee who
refuses to submit to such test to perform or continue to perform.
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G.
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Controlled substances use. No employee shall
report for duty or remain on duty when the employee uses any controlled
substances, except when the use is pursuant to the instructions of
a physician who has advised the employee that the substance does not
adversely affect the employee's ability. No employer having actual
knowledge that the employee has used controlled substances shall permit
the employee to perform or continue to perform his/her duties. An
employer may require an employee to inform the employer of any therapeutic
drug use.
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H.
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Positive test for controlled substances. No
employee shall report for duty or remain on duty if the employee tests
positive for controlled substances. No employer having actual knowledge
that an employee has tested positive for controlled substances shall
permit the employee to perform or continue to perform his/her duties.
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APPENDIX D
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City of Long Branch
Pre-Employment Drug Testing Policy and
Procedure
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The City of Long Branch is
dedicated to providing a safe workplace for its employees and residents.
In continuation of this commitment, it is the policy of Long Branch
to conduct pre-employment and for-cause drug screening programs. Job
applicants in Long Branch will undergo testing for the presence of
illegal drugs as a condition of employment.
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Procedure:
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1.
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Once a candidate is selected for a position
and an offer of employment is accepted, the candidate will be required
to undergo a pre-employment drug screen within 48 hours of the job
offer. All offers of employment will be conducted by the Personnel
Department and are conditional upon completion of a drug screening
test.
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2.
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Candidates will be instructed by the Personnel
Department where the nearest testing centers are located.
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3.
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Test results will be received by the City's
Medical Review Officer within three business days. Results will be
reported to the Personnel Department at the end of each business day.
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4.
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In the result of a positive test, a confirmation
test will then be conducted by the medical laboratory. If the results
of the confirmation test are positive, the offer of employment will
be rescinded.
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5.
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Supervisors will be notified by the Personnel
Department of the candidate's employment status.
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6.
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A minimum of one week will be required for the
above actions to take place.
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