Notification and Consent Form for Drug and Alcohol Testing for Minnesota Employers

I acknowledge that I have seen the Century Fence Company Pre-employment/Employment Drug and Alcohol Testing Policy.  I hereby consent to undergo drug and alcohol testing pursuant to said policy, and I authorize Century Fence Company through its agents and employees to collect a breath and/or urine and/or blood sample from me for that purpose.

I understand that the procedure employed in this process will ensure the integrity of the sample and is designed to comply with medico legal requirements.

I understand that the results of this drug testing may be discussed with and/or made available to Century Fence Company.  I further understand that the results of this testing may affect my job offer as described in the policy.

The purpose of collecting a body component sample of breath, blood, or urine is to test that sample for the presence of drugs and alcohol. A sample provided for drug and alcohol testing will not be tested for any other purpose. The name, initials and social security number of the person providing the sample may be requested so that the sample can be identified accurately but confidentially. Information about medications and other information relevant to the reliability of, or explanation for, a positive test result is requested to ensure that the test is reliable and to determine whether there is a valid medical reason for any drug, alcohol, or their metabolites in the sample. All data collected, including that in the notification form and the test report, is intended for use in determining the suitability of the job applicant for employment. The job applicant may refuse to supply the requested data; however, refusal to supply the requested data may affect the job applicant’s job offer. 

A Medical Review Officer may only disclose to Century Fence Company test result data regarding presence or absence of drugs, alcohol, or their metabolites, in a sample tested.  Century Fence Company or laboratory may not disclose the test result reports and other information acquired in the drug testing process to another employer or to a third party individual, governmental agency, or private organization without the written consent of the person tested, unless permitted by law or court order.  Evidence of a positive test result on a confirmatory test may be: (1) used in an arbitration proceeding pursuant to a collective bargaining agreement, an administrative hearing under Minnesota Statutes, Chapter 43A or other applicable state or local law, or a judicial proceeding, provided that information is relevant to the hearing or proceeding; (2) disclosed to any federal agency or other unit of the United States government as required under federal law, regulation, or order, or in accordance with compliance requirements of a federal government contract; and (3) disclosed as required by law, court order, or subpoena.  Positive test results may not be used as evidence in a criminal action against the applicant tested.

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Drug and Alcohol Policy Including Testing and Consequences

 

Century Fence Company believes in and is committed to providing a safe working environment for all employees that is free from the harmful effects of alcohol or drugs.  To that end, it is the company’s goal to achieve a drug-free workplace.  The company prohibits the unlawful use and/or possession of any substance, drug or intoxicant. This policy applies to everyone who works for the company in any capacity. Compliance with this policy is required as a condition of employment or continued employment with the company. An employee violating this policy will be subject to corrective action, up to and including discharge.

Employee use, possession, sale, purchase, transfer, or distribution of unlawful substances, drugs or intoxicants while on company premises, authorized work areas, vehicles or on company time or reporting to work under the influence of unlawful substance, drug or intoxicant will not be tolerated. Reporting to work intoxicated or when your ability is impaired by use of intoxicants or drugs is expressly forbidden, as is drinking or the possession or use of intoxicants, or illegal drugs, while on duty.  Employees who unlawfully use drugs and/or intoxicants do so at their own risk knowing such actions are grounds for immediate dismissal. In addition, illegal/unlawful substances found on company premises or worksites may be turned over to outside legal authorities for further investigation.

The Company has adopted a Drug and Alcohol Plan Policy with reference to the unlawful use and/or possession of any substance, drug or intoxicant.  Anyone who tests positive for illegal drugs as outlined in the testing procedures outlined below is subject to corrective action up to and including termination.  However, the employee will be referred to a Substance Abuse Professional (SAP) at his or her own expense.

If, through drug testing, an employee is found to be abusing “legal” drugs the company reserves the right to review the case on an individual basis, and the employee will be subject to corrective action up to and including termination.  Employees do need to communicate to their employer (supervisor and/or human resources) that they are taking medications/substances if the use of may impair the ability to safely perform duties and responsibilities of their position. 

If an employee is taking authorized prescription medications or over-the-counter drugs, he/she should consult with his/her health care provider about possible side effects which may affect the ability to safely perform his/her job. If the employee is concerned about side effects, the concerns should be discussed with his/her supervisor prior to the start of the workday.

Prescribed Drug Use:  This includes the use of legally prescribed drugs by licensed medical professional and over-the-counter drugs that may impair safety and/or job performance. If an employee is taking any drug, it is the employee’s responsibility to check with his/her health care provider for possible effects on safety or performance of the essential functions of his/her job. Any concerns should be discussed with the supervisor prior to the start of the workday.

Drug and Alcohol Use:  This includes, but is not limited to the use of:

Drugs which are illegal under all circumstances.

Prescription drugs which have not been legally prescribed or are not being used pursuant to a physician’s order. (This includes prescription drugs obtained from others.)

Reporting to duty under the influence of alcohol, using alcohol while on duty or misusing alcohol while off duty which results in an adverse effect on an employee’s ability to do his/her job.

 

The Company has an Alcohol and Drug Plan (U.S. Department of Transportation Federal Motor Carrier Safety Administration (FMCSA) that is issued to all employees hired in a safety sensitive position that is strictly adhered to during both the pre-employment and employment processes.  All employees will be asked to read and sign the “Acknowledgement/Receipt Form”.

  • Testing

Century Company reserves the right to test for violations of this policy as follows:

An applicant or employee who refuses to take a test for the presence of drugs or alcohol or refuses to cooperate in a company investigation involving unlawful substance, drug or intoxicant may face corrective action, up to and including discharge.

Pre-employment

Prospective employees will be required to take a post-offer, pre-employment test to screen for the presence of drugs in the system. While test results are used as criteria for rejecting any candidate, a positive test result will be grounds for further evaluation. All offers of employment will be contingent upon successful completion of the company’s pre-employment screening process.

Reasonable Suspicion

Where the company has reasonable cause to believe that an employee is under the influence of unlawful substance, drugs or intoxicants, the employee may be required to submit to a screening of drugs and alcohol.

Transportation to and from the testing facility will be provided by the company. Only qualified medical/laboratory personnel will administer drug and alcohol tests. All positive tests will undergo a second confirmation test. All test results, as well as the reason for the testing, will be treated as confidential information. Results will be shared on a need-to-know basis only.

Random

Century Fence Company reserves the right to randomly test employees for drugs and/or alcohol as outlined in this policy.  Random testing will be performed by an outside third party to ensure there is no bias in the selection of employees.  Century Fence Company has no say in the selection of employees and has no right to waive the selection of an employee selected.

Transportation to and from the testing facility will be provided by the company. Only qualified medical/laboratory personnel will administer drug and alcohol tests. All positive tests will undergo a second confirmation test. All test results, as well as the reason for the testing, will be treated as confidential information. Results will be shared on a need-to-know basis only.

Post-Accident

When an employee is injured as a result of an on-the-job accident and requires medical treatment away from the workplace or is involved in an accident which results in injury to another individual or damage to company property, the employee may be required to submit to a test to screen for alcohol and drugs if there is a reasonable basis to suspect that drug or alcohol use could have contributed to the accident.

Transportation to and from the testing facility will be provided by the company. Only qualified medical/laboratory personnel will administer drug and alcohol tests. All positive tests will undergo a second confirmation test. All test results, as well as the reason for the testing, will be treated as confidential information. Results will be shared on a need-to-know basis only.

As required per clients to gain entry onto worksite premises

Some clients require pre-access testing in order to gain access to their facilities to perform work. Transportation to and from the testing facility will be provided by the company. Only qualified medical/laboratory personnel will administer drug and alcohol tests. All positive tests will undergo a second confirmation test. All test results, as well as the reason for the testing, will be treated as confidential information. Results will be shared on a need-to-know basis only.

Return-to-Duty and Follow-Up

When an employee has violated the company drug and alcohol policy, he or she is required to undergo testing in order to return to his or her position according to the Substance Abuse Professional (SAP) assigned to the employee on a schedule determined by the same for the period of time required by the SAP.  All return-to-duty programs and testing assigned are at the expense of the employee solely.

 

Century Fence Company requires current employees to submit to these checks/examinations if legally mandated or if there is reasonable suspicion that the results may have changed or if new information is available.  Century Fence Company will pay all expenses other than Return-to-Duty which are covered by the employee.

Any employee who refuses to be tested or willfully fails to cooperate in the completion of any required testing process will be removed from their duties and will be subject to Company corrective action up to and including termination.  Failure to submit to testing will be equivalent to testing positive, subject to corrective action up to and including termination.

For CDL drivers only, the company may tolerate one (1) positive test, followed by the successful completion of a return-to-duty process at the employee’s expense.  The Company will refer the driver to a Substance Abuse Professional (SAP) as soon as practicable after the verified violation.  Consecutive positive tests will result in immediate termination. 

 The Company will cooperate fully with federal, state, and local authorities in their drug and alcohol-related investigations of Company employees.  Federal Law currently mandates that any person with a CDL is subject to mandatory substance screening. 

Counseling for alcohol and drug abuse problems is available to any employee of the Company, and its use is encouraged.  The Company participates in an Employee Assistance Plan (EAP), and counseling through its facility may be provided at low/reduced expense to the employee.  If additional counseling is needed beyond the EAP, it will be the financial responsibility of the employee.  For more information, see “Employee Assistance Program” under “Group Insurance Benefits”.

 

Consequences

Employees who violate this policy will be made aware of resources for resolving alcohol and drug problems, and must be evaluated by a substance-abuse professional. Employees must comply with treatment recommendations and undergo a return-to-duty test with a negative result. In addition, compliance with the provisions of the policies will be required. If terms of the policies are violated, the employee will be terminated.

The company recognizes that substance abuse or chemical dependency may be treated and urges those employees to seek assistance before it affects his/her work performance or results in corrective action.

A leave of absence may be granted to any employee who voluntarily seeks treatment for substance abuse. The leave of absence will be consistent with the company’s policies on medical and/or personal leaves of absence. The purpose of this leave will be for attending and successfully completing a recommended rehabilitation program. The cost of the rehabilitation program is the sole responsibility of the employee and may be covered under the company’s health insurance program for current participants. Please verify group benefits in your Summary Plan Description (SPD).

The company may also, at its discretion, offer a leave of absence to an employee who is found to have a problem related to drug and/or alcohol use. This treatment option is generally only offered on a one-time basis.

Alcoholism and drug addiction have been viewed as possible disabilities under state and federal discrimination laws. This means any individual who identifies himself/herself as a recovering alcoholic or recovering substance abuser will not be discriminated against in employment decisions based on the alcoholism or the drug addiction. However, it does not mean that alcohol or controlled substance consumption or activities in violation of this policy or consequences of such consumption are protected activities. Substance abusers and alcoholics are held to the same standards of performance as all other employees.