DRUG-FREE WORKPLACE RESOURCE GUIDE

P.O. Box 260700, Tampa, FL 33685 4904 Eisenhower Blvd, Suite 250, Tampa, FL 33634

(800) 869-8402; Fax (727) 791-1613

OKLAHOMA OPERATORS SELF-INSURERS FUND

Oklahoma Operators Self‐Insurers Fund  

DRUG‐FREE WORKPLACE RESOURCE GUIDE 

 Table of Contents 

Tab    Content 

1  Introduction and Guidelines 

2  Drug‐Free Workplace Program Implementation Checklist 

3  Contact Information – Arthur J. Gallagher Risk Management Services, Inc. 

4  Drug‐Free Workplace Resources  

5  Services Available from Fellers, Snider, Blankenship, Bailey & Tippens, P.C. 

6  Drug and Alcohol Policy – Template 

7  Consent Form for Drug and Alcohol Testing – Template 

8  List of Drug Testing and MRO Services 

9  Sample Provider Alert from Company Nurse 

10  Oklahoma OSIF Drug Testing Fees Guarantee Letter 

11  SAMHSA –            Drugs in the Workplace – What an employer needs to know 

12  U.S. Department of Labor – Working Partners for Alcohol and Drug Free Workplace           Top 12 Reasons Why a Good Drug­Free Workplace Program Goes Bad 

  

INTRODUCTION AND GUIDELINES  The statistics speak volumes, and the impact on the workplace is clear.  Substance abuse is a growing problem, and if carried into the workplace will have an enormous effect on your bottom line.  Food preparation workers are among the industries with the highest rate of illicit drug use.  Drug users are more likely to be involved in accidents and file workers’ compensation claims, and medical costs for drug‐users are much higher (twice as high according to SAMHSA) than non‐drug users.  The Board of Directors for the Oklahoma Operators Self‐Insurers Fund (Oklahoma OSIF) is encouraging each member to implement a drug‐free workplace program and feels this measure will lead to improved safety in your workplace, as well as significant cost savings.   The Fund is now offering a premium discount for members who meet qualifications for drug‐free workplace.    If you have already implemented a drug‐free workplace program, evaluate your program based on the information provided in this resource manual.   Can your current program be improved?  When was the last time your substance abuse policy was updated?  Will it be upheld in the current legal system?    For those who have not yet implemented a drug‐free workplace program, this resource will help you begin the process.  You are provided with step‐by‐step instructions, checklists, articles, and sample policies and forms.    The following six steps are recommended to implement a drug‐free workplace program and obtain the Oklahoma OSIF drug‐free discount: 

1. Develop your written substance abuse policy 2. Arrange procedures for drug and alcohol testing 3. Train & educate employees 4. Provide documentation to Arthur J. Gallagher 5. Comply & enforce your policy 6. Enjoy your drug‐free workplace! 

 Arthur J. Gallagher (AJG) offers their resources and serves as your partner through each of the 6 steps, from development to implementation and ongoing maintenance of your drug‐free workplace program.  See tab 3 for AJG contact information.   

STEP ONE:  DEVELOP YOUR WRITTEN SUBSTANCE ABUSE POLICY    An essential component of an effective drug‐free workplace program is a thorough written policy that complies with federal, state and local laws.  The policy should specify exactly who will be tested, when they will be tested, how the test will be administered, and what will be the consequence of a positive test.    Drug‐free workplace programs may include various types of testing:  pre‐employment, for cause, periodic, random, or post‐accident.   In order to qualify for the Oklahoma OSIF drug‐free discount, you only need to perform post‐accident testing.   

To help you develop a legally sound policy, we have provided you with the following information: 

1. Drug and Alcohol Policy Template (see tab 6) 2. Sample Consent Form for Drug and Alcohol Testing (see tab 7) 

 It is recommended that you contact a labor attorney to assist in adapting a policy specifically for your organization, and to ensure the policy includes verbiage in accordance with current statute.  We have provided the contact information for a labor attorney, Kevin Donelson, who can assist you from start to finish (see tab 5).   

STEP TWO: ARRANGE PROCEDURES FOR DRUG AND ALCOHOL TESTING  Drug and alcohol testing procedures must be arranged before implementing your drug‐free workplace program.    Please be aware of the resources available to you if you have questions or need assistance with this step.  Each of the following individuals has offered to assist you in identifying and contacting potential drug‐testing facilities (see tabs 3, 4 & 5 for full contact information):  

Rodney Vinson, Arthur J. Gallagher – (727) 796‐6205 Kevin Donelson, Fellers, Snider – (405) 232‐0621 Dr. Howard Taylor, National Toxicology Specialists – (615) 353‐1888 

 Additionally, George Davis, an Operator in the Ponca City & Blackwell markets has gone through the process of contacting and negotiating drug testing procedures with medical facilities, and he is willing to assist.  George can be reached at (405) 512‐9775.  1)  Identify a qualified drug and alcohol testing facility 

To arrange drug testing procedures, the first step is to identify a medical facility that offers qualified specimen collection, laboratory, and MRO services.  The Medical Review Officer (MRO) is a medical professional who is responsible for receiving and reviewing all confirmed “positive” test results.  Ideally, the medical provider your organization uses for employee injuries will have all the necessary qualifications and procedures already in place.  Many of these facilities will have already been performing drug testing for other businesses in your area.  If your medical provider does not have the qualifications to perform specimen collection, laboratory, and/or MRO services, alternative providers must be identified and utilized.  Again, AJG can assist you in identifying alternative solutions.   2)  Conduct an onsite meeting to arrange drug and alcohol testing procedures  

The second step is to arrange for a meeting with the drug testing facility.  It is recommended that you meet with your medical provider face‐to‐face.  This is an opportunity to establish (or re‐establish) a relationship with the medical professionals who serve your employees.  You as the employer and they as the medical provider share in common concern for your employees.  A personal relationship will serve as an advantage in making sure your employees receive prompt and effective medical treatment and the medical providers do everything they can to help get your employees back to work as quickly as possible.  Medical administrators will appreciate the relationship knowing who they can contact when they have questions or concerns regarding services they are rendering for your employees.    

 The following are notable points to discuss when meeting with the administrator of a medical facility to arrange procedures for drug and alcohol testing:   

Discuss your organization’s implementation of your drug‐free workplace program. 

Emphasize the purpose of the program is to improve the safety, health, and well‐being of your employees.   

Determine whether or not the medical facility offers:   

1) Specimen Collection 2) Laboratory Testing  3) MRO Services 

Some facilities will offer all three phases of the process.  Others might collect the specimen and send for offsite testing and medical review.  At a minimum, attempt to arrange for the medical facility to collect a specimen and send it to an agreed lab for testing.  Separate arrangements may need to be made with a lab and MRO.   

Explain that a provider alert will be sent to them from your work comp representative, Company Nurse, which serves as notification that an injured employee will be coming for medical treatment.  Your company’s drug‐testing requirement is highlighted in the “Special Handling” section of this fax.  A sample provider alert is provided (See tab 9).  Provide a copy of this sample to the medical facility.   

Ensure drug and alcohol testing will be done using approved methods: 

Collection must be done with due regard to the privacy of the employee  Biological samples must be labeled  A written chain of custody of the samples must be maintained from the time 

of collection until the samples are no longer required  Split sample testing methodology should be used:  The specimen is divided 

into two bottles by the collector – one for primary testing and confirmation and the other to be sent to another lab for testing if the employee so requests 

An MRO must review all positive test results.  The employee must be given an opportunity to speak with the MRO to 

demonstrate any legitimate reason for the positive test result.    Determine how test results will be reported to you the Owner/Operator. 

Discuss record keeping procedures.  Will a record of the test be kept with the medical facility, the MRO, or both? 

Determine the testing fees.  Notify the facility that drug and alcohol testing fees for post‐accident testing will be paid by the Oklahoma Operators Self‐Insurers Fund.  Provide a letter from the Fund, guaranteeing it will be responsible for paying the drug and alcohol testing fees (See tab 10). 

 By discussing these notable points, you will have identified the drug testing process, how the test will be administered, and how results will be communicated. 

 

STEP THREE:  TRAIN & EDUCATE EMPLOYEES  All managers and employees must have at least 10 days notice before your drug‐free workplace program goes into effect.    Your shift managers should be the first to be trained on the policy.  They should understand the program well enough to explain it to employees as well as enforce it.  Provide a written copy of the policy to the shift managers, and review it with them in detail.  Review the drug and alcohol testing procedures, which you arranged in step two.  Allow for discussion, questions, and clarification.  Once shift managers are properly educated, present the drug‐free workplace program to all your employees.  Provide a written copy of the policy to each employee, and provide an opportunity for them to ask questions and receive clarification.  Emphasize the reason for the drug‐free workplace program is to increase the safety of the workplace.  Each employee subject to the policy must understand the program including (at minimum): 

1) Who will be tested 2) When they will be tested 3) How the test will be administered 4) The consequences of a positive test result 5) The consequences of refusing the test 

 All current employees must sign the employee acknowledgement/consent form.  Prospective employees must be aware of the program and, if hired, must sign the employee acknowledgment/consent form.  Employees or prospective employees who are minors must have a parent or legal guardian sign the acknowledgement/consent.    Orientation, training programs, and employee handbooks need to be updated to incorporate the drug‐free workplace program.    Post a “Drug‐Free Workplace” poster at all entrances of the store as well as on the employee bulletin board.  Posters are provided with this manual. 

STEP FOUR:  PROVIDE DOCUMENTATION TO ARTHUR J. GALLAGHER  Once a written policy has been developed, testing procedures have been identified, employees have been properly educated and trained, and employee acknowledgement/consent forms have been collected, provide Arthur J. Gallagher with the following information and a discount will be applied on your Oklahoma OSIF workers’ compensation policy:   

1. A copy of your written substance abuse policy 2. A copy of your employee acknowledgement/consent form 3. The name of the facility who will be performing the drug and alcohol tests 

 Arthur J. Gallagher will collaborate with Company Nurse, who will help facilitate the testing when an employee injury is reported.   

STEP FIVE:  COMPLY & ENFORCE YOUR POLICY  Be consistent.  Follow up to ensure drug and alcohol tests are performed for every employee involved in a work related injury.  No exceptions!  If you find an employee was not tested at the initial doctor visit, send them back to be tested even if it is a day, week, or even months later.  Your policy will lose its effectiveness if it is inconsistently enforced.    Make the protection of your employees’ confidentiality a priority.  Test results should not be shared with anyone unless they specifically need to know.  Protecting your employees’ confidentiality will help you gain employee support of the program, and help you avoid legal issues. 

STEP SIX:  ENJOY A DRUG­FREE WORKPLACE!  According to SAMHSA (see tab 11), Drug‐Free workplace programs: 

Decrease:  absenteeism, accidents, downtime, turnover, theft, workers’ compensation costs, and employee discipline problems. 

Increase:  productivity, employee morale, profits, customer satisfaction, and employee health status.  

 

We are confident you will enjoy these benefits and more as you implement and maintain your drug‐free workplace program.    

NOTICE This Drug‐Free Workplace Resource Manual  is designed  to be used  for general guidance and  information about implementation of a drug‐free workplace program.  Drug‐free workplace programs and drug‐testing may expose your organization to  legal  issues,  if not performed and documented properly.   The Oklahoma Operators Self‐Insurers Fund and Arthur J. Gallagher disclaim any responsibility for the implementation of your substance abuse policy.  You are advised to seek legal counsel prior to implementing or updating your drug‐free workplace program.   

DRUG­FREE WORKPLACE PROGRAM IMPLEMENTATION CHECKLIST:  

       Step One:  Develop a Written Substance Abuse Policy  

   Step Two:  Arrange Procedures for Drug and Alcohol Testing 

   Step Three:  Training & Education 

   Educate and Train Shift Managers 

   Educate Employees 

   Provide Each Employee with a Written Copy of the Policy 

   Obtain Signed Employee Acknowledgment/Consent 

   Post a Copy of the Written Policy in the Store 

   Hang “Drug‐Free Workplace” Posters 

   Step Four:  Provide Documentation to Arthur J. Gallagher 

   Step Five:  Comply & Enforce Your Policy 

   Step Six:  Enjoy a Drug‐Free Workplace! 

   

CONTACT INFORMATION    Arthur J. Gallagher will serve as your partner through each step of the process, from development to implementation and ongoing maintenance of your drug‐free workplace program.  For  questions  or  assistance  regarding  Oklahoma  OSIF’s  drug‐free  initiative, contact Arthur J. Gallagher Risk Management Services, Inc.   

Rodney Vinson, National Programs Loss Prevention Manager 

727‐796‐6205 Rodney_Vinson@ajg.com 

 Ben Johnson, 

Assistant Fund Administrator 727‐796‐6231 

Ben_Johnson@ajg.com  

Lowell Fuller, Fund Administrator 727‐796‐6107 

Lowell_Fuller@ajg.com  

 Arthur J. Gallagher Risk Management Services, Inc. 

4904 Eisenhower Blvd, Suite 250 Tampa, FL  33634 

 Phone:  (800) 869‐8402 Fax:  (727) 791‐1613 

Drug­Free Workplace Resources   Fellers, Snider, Blankenship, Bailey & Tippens, P.C. Kevin Donelson, Phone: 405‐232‐0621,  Email: kdonelson@fellerssnider.com  

A  labor  attorney  should  be  consulted  when  implementing  or  updating  a  drug‐free workplace program.    Kevin  Donelson,  of  Fellers  Snider,  is  the  labor  attorney  who drafted  the  policy  templates  provided  in  this  resource  guide.      He  offers  drug‐free program implementation assistance, training, and support. 

  National Toxicology Specialists (NTS)  website: www.drugtestinfo.com Dr. Howard Taylor,   Phone: 615‐353‐1888,  Email: htaylor@drugtestinfo.com  

  NTS has implemented and/or managed nationwide drug free workplace programs for over 14 years.  The Fund has consulted with Dr. Howard Taylor, and he is an excellent resource  for  assistance  in  policy  development,  training,  regulatory  compliance,  and drug‐testing procedures.   

  Substance  Abuse  and  Mental  Health  Services  Administration  (SAMHSA)  ‐  Division  of Workplace Programs:    http://workplace.samhsa.gov  

  SAMHSA is one of the operating divisions of the United States Department of Health and  Human  Services  (HHS).      SAMHSA’s  Division  of  Workplace  Services  provides oversight for the Federal Drug‐Free Workplace Program and the National Laboratory Certification Program.  The Division also provides resources for comprehensive drug‐free workplace programs. 

  National Institute on Drug Abuse (NIDA):  www.nida.nih.gov  

NIDA performs scientific research on drug abuse and addiction, addressing the most fundamental and essential questions about drug abuse. 

  Occupational Safety & Health Administration (OSHA):  www.osha.gov/SLTC/substanceabuse  

  OSHA was created to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education  and  assistance.    This  website  includes  a  link  to  the  U.S.  Department  of Labor Drug‐Free Workplace Advisor. 

  United States Department of Labor – Working Partners for Alcohol and Drug‐Free Workplace (Working Partners):   www.dol.gov/workingpartners  

  Working  Partners  was  a  governmental  outreach  initiative  to  assist  employers  to develop  drug‐free  workplace  programs.    The  program  has  been  closed,  but  many resources  are  still  available  on  this  website,  including  the  Drug‐Free  Workplace Advisor. 

Oklahoma OPERATORS SELF-INSURERS FUND

A Fund Administered by Arthur J. Gallagher Risk Management Services, Inc. P. O. Box 260700, Tampa, Florida 33685-0700

4904 Eisenhower Blvd, Suite 250, Tampa, Florida 33634 Phone 1-800-869-8402 Fax (727) 791-1613

Lowell D. Fuller Administrator

  

Kevin R. Donelson Attorney 

 Cathy Roesel 

Secretary to Kevin R. Donelson  

Fellers, Snider, Blankenship, Bailey & Tippens, P.C. 100 N. Broadway, Suite 1700 

Oklahoma City, OK  73102‐8820 Telephone:  (405) 232‐0621 Facsimile:   (405) 232‐9659 

  

The following services are available from the above for a flat fee:    

o Tailor the drug testing policy and related templates to your individual business model 

o Assist in identifying drug testing facilities and a medical review officer in your area 

o Conduct on‐site meetings with store managers and assistant store managers for implementation and training 

o Provide on‐going support to assist in answering questions regarding drug testing and other employment related issues  

DRUG AND ALCOHOL TESTING POLICY I. POLICY SUMMARY: While the decision to drink alcohol is the individual’s, the use of and the abuse of alcohol on _________________’s (“Company” or “____________”) time, at Company expense, while on Company business or at Company-sponsored events is not permitted. The Company believes that employees who take prescription drugs as directed by a physician or use over-the-counter drugs in compliance with package directions are behaving responsibly. All other uses of drugs are unacceptable. Alcoholism and drug addiction are treatable diseases and the Company is committed to assisting alcohol and/or drug dependent employees under certain circumstances who are willing to follow a prescribed and approved rehabilitative process. To help ensure a safe, healthy, and productive work environment, the Company has an alcohol assessment and drug-screening program that involves post-accident screening as permitted by applicable law. II. POLICY GUIDELINES: Notification of Alcohol Assessment or Drug Screening

All employees will be provided a notice of the drug and alcohol use and testing policy at minimum of 10 days prior to the scheduled implementation date of __________________, 2012. Employees may be informed of the Company’s policies on alcohol and drug testing through various verbal and written communications. Any current employees subject to drug and alcohol testing following a workplace accident or injury will be asked to sign an appropriate consent form prior to undergoing a drug test. Failure to comply with all aspects of the drug testing process, including failure to sign an appropriate consent form to undergo a drug test, will result in disciplinary action up to and including possible termination. Use of Alcohol and/or Drugs on Company Premises, at Company Functions and While Driving

Employees are not permitted to report to work while intoxicated or to operate machinery while under the influence of alcohol or drugs that may affect their ability to work safely. Except when following a physician’s advice, employees may not report to work under the influence of a drug nor may they bring drugs into the workplace. Employees using prescription drugs according to their physicians’ directions need to discuss with their physicians or the Company’s Medical Review Officer (“MRO”) any job safety concerns they may have about the effects of such drugs. Employees are not permitted to bring alcoholic beverages onto Company premises. Employees may never drive on Company business while under the influence of alcohol and/or drugs.

2

Employees who are assigned Company vehicles may never drive that vehicle while under the influence of alcohol and/or drugs. Alcohol Assessment and/or Drug Screening A. Substances Tested

When conducting drug and alcohol testing, the Company tests for the drugs and alcohol as defined in and in accordance with the Standards for Workplace Drug and Alcohol Testing Act. The term "illegal drug" does not include the use of a drug obtained and taken under supervision by and in accordance with prescriptions or other instructions issued by a licensed health care professional and other drugs otherwise authorized to be used under the Controlled Substances Act. B. Post-Accident Testing The Company will require an employee to undergo drug or alcohol testing if the employee or another person has sustained an injury while at work or the Company’s property or equipment has been damaged.

III. PROCEDURES: Consequence for Refusing to Undergo Testing

Employees who refuse to cooperate with the terms of this Policy or refuse to undergo drug screening or testing when requested or conducted by the Company shall be subject to disciplinary action, up to and including termination. A refusal to undergo drug and/or alcohol testing includes, but is not limited to, engaging in conduct which obstructs testing such as failure to sign necessary paperwork, failing to report to the collection site at the appointed time and failing to be reasonably available for a post-accident test. In addition, adulterating, substituting or tampering with the sample will result in disciplinary action, up to and including termination. Consequences for Positive Test Results

Employees who are under the influence of or who test positive for drugs and/or alcohol shall be subject to discipline, up to and including termination. Disciplinary action will be taken based on a positive test result after the test result has been confirmed with a second test. Although the discipline imposed is contingent on case-by-case circumstances, and the Company reserves the right to determine in its discretion the discipline imposed, ordinarily a confirmed positive drug and/or alcohol test will result in termination. In addition, a positive drug and/or alcohol test may impact an employee’s entitlement to workers’ compensation benefits and/or unemployment benefits.

3

Confidentiality And Privacy

The Company shall maintain all drug and alcohol test results and related information as confidential records. Such records and information maintained by the Company shall be Company property and, upon the request of the employee tested, shall be made available for inspection and copying to the employee. The Company shall not release such records to any person other than the employee or the Company's Medical Review Officer (“MRO”), unless the employee, in writing following receipt of the test results, expressly grants permission for the Company to release such records or pursuant to a valid court or administrative order. Employees have the right to obtain all information and records related to that individual's testing. To receive information and records, the employee tested must deliver a written request to the Company’s Owner/Operator. The written request must be signed by the employee tested and state whether the information and records are to be sent to the employee’s home address or whether that employee will personally pick up the records. The Company will not release any records to any person other than the employee tested or the Company’s MRO reviewing the test, unless the employee tested has, in writing, expressly granted permission for the Company to release such records or pursuant to valid court or administrative order. A reasonable amount of time is given to the Company to comply with the request for information and records. An employee has the right, to be exercised within 24 hours, after a request by the MRO or after notification of test results, to explain, in confidence, the test results. Failure to notify the MRO will result in disciplinary action, up to and including immediate termination. Testing and Collection Methods

All drug and alcohol testing, including the collection of testing samples, shall be conducted in accordance with Oklahoma law. To ensure the integrity and accuracy of each test, all specimen collection, analysis, and laboratory procedures shall be conducted in accordance with the Oklahoma Standards for Workplace Drug and Alcohol Testing Act (the “Act”). This includes, among other things: (i) procedures to ensure the correct identity of each employee at the time of testing; (ii) maintenance of a written chain of custody of the sample from the time of collection until the sample is no longer required; (iii) the use of qualified testing facilities and personnel; (iv) collection of samples performed under reasonable and sanitary conditions with due regard to privacy; (v) collection, storage and transportation of samples to the testing facility performed so as to reasonably preclude the probability of sample contamination or adulteration; (vii) and appointment of a qualified Medical Review Officer (MRO) to review drug test results before such results are reported to the Company’s designated representative. To further facilitate the integrity and accuracy of each test, the Company will provide employees written and/or oral instructions regarding the conduct of the specific test before each testing event. All such instructions shall be deemed a part of this Policy. Employees who refuse or otherwise fail to comply with all such instructions will be subject to disciplinary action, up to and including termination.

4

Drug Tests

All drug tests conducted under this policy require that an employee must provide a specimen of his/her urine, blood, and/or saliva. Specimens will be analyzed for the presence of drugs and other substances as permitted by federal and/or state law. Employees will be permitted to give a urine specimen in privacy and without being observed by collection site personnel. However, collection shall be in a manner reasonably calculated to prevent substitutions or interference with the collection or testing of reliable samples. Before being tested for drugs, employees will be given an opportunity to provide notification of any information which the employee considers relevant to the test, including the identification of currently or recently used prescription or nonprescription drugs or other relevant information. All drug tests will be administered using the split sample methodology. Under this methodology, an employee must provide at least 45 milliliters (ml) in a specimen container. The specimen will then be divided into two specimen bottles by the collector. Thirty (30) ml will be poured into one bottle and fifteen (15) ml into a second bottle. Both bottles will be sent to the laboratory. The bottle containing 30 ml will be analyzed as the employee’s primary specimen. The second bottle will be held by the laboratory, to be sent to another lab at the employee’s request in the event that the primary specimen is verified as positive. Before the primary specimen test will be verified as positive, it will be confirmed by a second test as required by the Act. In the event the primary specimen is verified as positive, the employee will be notified by the Company’s MRO of the positive test and given the option to have the second bottle sent to a different laboratory for analysis. To exercise this option, the employee must advise the Company’s MRO within 24 hours of being told that the primary specimen was positive. Except for the use of methadone and medications containing alcohol, nothing in this Policy prohibits an employee’s use of a medication legally prescribed by a licensed physician: (i) who is familiar with the employee’s medical history and specific safety sensitive duties, and (ii) who has advised the employee that the prescribed medication will not adversely affect the employee’s ability to perform his/her duties safely. Medications prescribed for someone other than the employee, however, will not be considered lawfully used when taken by the employee under any circumstances. Alcohol Tests

All alcohol tests conducted under this Policy require that the employee must provide a breath, saliva, blood, and/or urine specimen for any test conducted by, or on behalf of, the Company. In the case of an alcohol test by a law enforcement officer following an accident, the employee must provide either a breath or blood specimen, as directed by the law enforcement officer. Alcohol tests may be administered using a breath specimen, taken by a breath alcohol technician (BAT) using an approved breath testing device (EBT), except in cases of on scene/post accident testing conducted by federal, state or local officials. Before being tested by, or on behalf of, the Company, each employee will be required to (i) present his/her personal identification, and (ii) execute a breath alcohol test form provided by the BAT. An employee who refuses to provide his/her identification, provides a false identification,

5

refuses to execute the breath alcohol test form, or who otherwise refuses or fails to cooperate will be treated as though he/she had tested positive and will be subject to disciplinary action, up to and including discharge, in addition to the penalties imposed by federal and state regulations. Prior to each alcohol breath test conducted by the Company, the BAT will instruct the employee on how the test will be performed. To protect each employee, the BAT will open and attach to the testing device an individually sealed mouthpiece in the employee’s view. The employee will then be directed to blow forcefully into the breath testing device until an adequate amount of breath has been maintained. In the event that an employee is unable to provide an adequate amount of breath for the initial or confirmatory test after several attempts to do so, the employee will be required to submit to an evaluation by a licensed medical physician to determine whether a valid medical condition exists. If the Physician determines that a valid medical condition does exist, the test result will be reported to the Company as “negative.” If the physician determines that a valid medical condition does not exist, the test result will be reported to the Company as a “confirmed positive.” For Drug Tests

Before an employee’s test result will be confirmed “positive” for drugs, the employee will be given the opportunity to speak with the Company’s MRO and demonstrate that there was a legitimate medical explanation for the positive test result. If the MRO determines that a legitimate medical reason does exist, the test result will be reported to the Company as “negative.” If the MRO determines that a legitimate medical reason does not exist, the test result will be reported to the Company as a confirmed “positive.” An employee may request a confirmation test in accordance with the Act of a sample within 24 hours of receiving notice of a “positive” test. The employee shall pay all costs of such confirmation testing. However, the employer shall reimburse the employee for the costs of the confirmation testing if such testing reverses the findings of the challenged positive test. Pending the outcome of this additional analysis, the employee may continue being considered physically unqualified to work. An employee whose test result is confirmed “positive” for drugs will be considered unqualified to perform or continue performing his/her functions safely and will be subjected to disciplinary action, up to and including immediate termination. For Alcohol Tests

In the event that an employee provides an adequate breath specimen and the initial test registers an alcohol concentration level that is less that 0.02, the test result will be reported as a “negative” and no additional test will be required at that time. In the event that an employee provides an adequate breath specimen and the initial test registers an alcohol concentration level of 0.02 or greater, a second confirmation test, in accordance with the Act will be performed. In the event that an employee provides an adequate breath specimen

6

and the confirmation test registers less than 0.02, the test result will be reported to the Company as “negative.” Any employee whose confirmation test registers a positive test will be subject to disciplinary action, up to and including immediate termination. Maintaining Contact with the Company and MRO After a Drug Test Employees who are tested for drugs or alcohol are required to remain in contact with the Company the Company’s MRO while awaiting the results of their tests. Employees should advise the Company of their whereabouts and the telephone number where they can be reached during this time. The Company’s MRO is __________________________________________________. An employee who refuses or fails to remain in contact with the Company’s MRO will be considered insubordinate and subject to disciplinary action, up to and including termination. In addition, an employee who fails to remain in contact may waive his/her right to speak with the Company’s MRO before a test is confirmed “positive.” IV. RIGHT TO TERMINATE OR AMEND POLICY:

The Company reserves the right to modify, suspend, change or terminate this policy at any time. This policy does not create any contractual rights or obligations, whether express or implied.

CONSENT FORM FOR

ALCOHOL AND DRUG TESTING

EMPLOYEES AND PROSPECTIVE EMPLOYEES RECEIVING A CONDITIONAL OFFER OF EMPLOYMENT

Chemical testing consists of analysis of urine, blood, saliva and/or breath to determine the presence or absence of psychoactive chemicals to include alcohol. In cases of blood testing, biological samples will be obtained at a qualified and licensed facility by a licensed physician or nurse (RN or LPN). Breath analysis will be performed by a person qualified to administer a breath analysis. Urine collection will be accomplished by a trained collector. It is anticipated that urinalysis will be the primary mode of chemical testing. Chemical testing is required for all employees to assure compliance with the Company’s Drug and Alcohol Policy. I, ____________________________________ do hereby consent to provide a urine, blood, saliva, breathalyzer, or other biological specimen. I hereby authorize the test results to be sent to ___________________, the Owner/Operator. I further understand, authorize, and consent that the Owner/Operator may make the results available on a need to know basis to other authorized personnel and managers of __________________. This authorization also provides my consent to all future requests for my biological specimen as long as I am an employee of this company. I understand my failure to honor the terms of this consent form is grounds for termination of my employment or my application for employment. I am willing that a facsimile copy of this authorization be as valid and effective as the original at any time hereafter irrespective of the date hereof. I certify that I have read, understand, and have received a copy of _________________ Drug and Alcohol Policy. Signed (Employee) ___________________________ SS#_______________________ Print Name______________________________ Date of Birth________________________ Date___________________________________ Witness________________________________ If employee is under the age of 18, a parent/legal guardian must sign below: Signed (Parent/Legal Guardian) ___________________________________ Print Name ___________________________________________

MRO Services:National ToxicologySpecialists - Dr. Howard TaylorPH: 615-353-1888Email: htaylor@drugtestinfo.comWeb: www.drugtestinfo.com

SAMPLE

B302346Q

480 222-0800 623-321-1511

Mesa AZ 85202

Test Clinic

Employee, Test

123 Main St Any City AZ 85001

12345 Home Blvd Apt C25

Provider Injury Alert

Call Confirmation # Time :

Phone : Fax :

480-374-2450Home Phone:Scottsdale AZ 85258

Test Company- Dept: Location

MaryJane Johnson 333 333-3331Phone:

Medical Professional ANGTST…06/16/2010 09:34:51

Employee/Patient Information Employer Information

TO

** Confidential **

666 666-6666 666 666-6667

Test Insurance9512 Claims St Suite 1526 Phoenix AZ 85001Phone: Fax:

Workers' Compensation Insurance Carrier (For All Medical Bills)

Test Corporate Name 8553 Test Street

17000001

DU006972 TEST , TEST1 , TEST

TESTINS

This employer believes that early RETURN-TO-WORK promotes the healing process. Pleasecontact the RTW coordinator,Susan Coord, at 333 333-3333 for a detailed job description sothat you can write a RTW activity prescription to guide the employer in attempting to find atemporary alternate position.

Dear Medical Provider:Please note that the above mentioned injured employee will be coming to your facility seeking treatmentfor a reported workplace injury.

Special Handling Instructions:Please be advised that this employer requires DRUG TESTING.

09/28/2009 08:00:00 garageDate\ Time of Incident Work DepartmentDate\ Time - Reported Local Time

09/28/2009 09:05:00

Cuts, Lacerations, Scrapes, Punctures Nature of Incident

MondayDay of week

Hand RightBody Part

4658 Test Location Blvd, Suite 5 Pasadena 99911 CAInjury Location

· any wound (including superficial) and last tetanus booster > 5 years ago? - Yes

Guidelines

4. OCC HEALTH NEXT OFFICE HOURS (MUST BE WITHIN 72 HOURS)Call back to Company Nurse if symptoms worsen, new symptoms occuror questions arise.24. Keep wound clean and dry, OTC analgesics as needed, may return to duty in

Care Advice

Upon completion of your initial treatment, please fax to details and a work status report.

Please note that workers' compensation benefits are governed by state statute. Although we do our best to ensure that theseinjuries are in fact work related, no guarantee is made that these are legitimate claims under workers' compensation laws.

333 333-3334

SAMPLE

meantime, may apply ice or heat to wound for comfort, maintain injured part inposition of comfort.

1. Please describe your medical complaint.1" laceration to palm of right hand.2. How did the accident happen? (Please state all details)Employee was cutting lettuce and cut her hand.3. Please specify machine, tool, substance or object most closely connected with the accident.Knife4. What was the employee doing when accident occurred?(i.e. loading truck, walking down stairs, etc)Cutting lettuce for student lunches.Medical History:Other:6. Essential Nursing Notes:TEST REPORT TEST REPORT TEST REPORT TEST REPORT TEST REPORT TEST REPORT

Triage Description

Upon completion of your initial treatment, please fax to details and a work status report.

Please note that workers' compensation benefits are governed by state statute. Although we do our best to ensure that theseinjuries are in fact work related, no guarantee is made that these are legitimate claims under workers' compensation laws.

333 333-3334

SAMPLE

06/16/2010 09:34:51

Work Status and Treatment Plan

Dear Medical Provider: Please legibly complete this form in its entirety and FAX to

a claim. Your cooperation is appreciated.Test Company- Dept: LocationEmployer:

333 333-333424 hours of treatment being rendered. Immediate attention to this will expedite the receipt of the proper authorizationand billing payments to your office. Reporting requirements vary by state and must still be completed to formally file

within

TEST1 , TEST

B302346QCall Confirmation # Time :Confidential

Provider InformationTest Clinic123 Main St Any City AZ 85001

480 222-0800 623-321-1511Phone : Fax :

17000001

Employee InformationEmployee Test 12345 Home Blvd Apt C25 Mesa AZ 85202

480-374-2450

12/12/1935

Phone :

DOB :

09/28/2009 08:00:00 garageDate\ Time of Incident Incident LocationDate\ Time - Reported Local Time

09/28/2009 09:05:00

Date, Time, and Place of Incident\ Report

MondayDay of week

DU006972

Subjective Complaints

Diagnosis

X-Ray Results

Findings Upon Physical Exam

Treatment Recommendations

Medications Prescribed

Released to Return to Work on ______________________________ Light Duty _______ Reg. Duty ________Work Restrictions

Work Status

Signature

Follow-Up Appointment______________________________

Title Date

Upon completion of your initial treatment, please fax to details and a work status report.

Please note that workers' compensation benefits are governed by state statute. Although we do our best to ensure that theseinjuries are in fact work related, no guarantee is made that these are legitimate claims under workers' compensation laws.

333 333-3334

Oklahoma OPERATORS SELF-INSURERS FUND

A Fund Administered by Arthur J. Gallagher Risk Management Services, Inc. P. O. Box 260700, Tampa, Florida 33685-0700

4904 Eisenhower Blvd., Suite 250, Tampa, Florida 33634 Phone 1-800-869-8402 Fax (727) 791-1613

Lowell D. Fuller Administrator

 [Date]    [Name] [Entity] [Address] [City, St  Zip]  RE:  Guarantee of Post‐Accident Drug‐Testing Fees  Dear [Name]:  This letter serves as guarantee that all fees related to post‐accident drug testing for your policy 75292‐XXX will be the responsibility of the Oklahoma Operators Self‐Insurers Fund.    Invoices for post‐accident drug tests should be sent to the following address and should include, at minimum, the claimant’s name and social security number:    Oklahoma Operators Self‐Insurers Fund  

c/o Gallagher Bassett Services   PO Box 23812   Tuscon, AZ  85734  Please provide this guarantee letter to the  medical provider who will be performing post‐accident drug testing.  If you have any questions, please feel free to call me at 727‐796‐6107.  Sincerely,  

  

Lowell Fuller, Fund Administrator   

1

Substance abuse is a widespread problem in our society. An estimated 14.8 million Americans are current illicit drug users.1 The Substance Abuse and Mental Health Services Administration reported that 77 percent of illicit drug users in the United States are employed. That’s 9.4 million people. The chances are good that your organization employs one of these workers.

Who is using drugs at work?

A survey by the federal government showed full-time employees who admitted to being current illicit drug users tend to be:

■ between the ages of 18 and 25 ■ less educated

■ male ■ divorced or never married

■ white ■ low paid2

Industries with the highest rates of illicit drug use

■ food preparation workers

■ waiters, waitresses, and bartenders

■ other service occupation workers

■ construction workers

■ workers in transportation and material moving3

DRUGS IN THE WORKPLACE — What an employer needs to know.

Drug abuse can affect

anyone. You can’t tell

if someone uses drugs

by looking at them.

2

How does substance abuse impact the workplace?

Employees who abuse alcohol and other drugs bring their problems with them to work.

Substance abuse lowers productivity.

■ Problems related to alcohol and drug abuse cost American businesses roughly $81 billion in lost productivity in just one year.4

■ Studies have shown that substance-abusing employees function at about 67% of their capacity.5

Substance abuse causes accidents and injuries.

■ Up to 40 percent of industrial fatalities and 47 percent of industrial injuries can be linked to alcohol use and alcoholism.6

■ Employees who use drugs are 3.6 times more likely to be involved in a workplace accident and 5 times more likely to file a workers’ compensation claim.7

Substance abuse increases absenteeism and turnover.

■ An estimated 500 million workdays are lost annually due to alcoholism.8

■ Employees who use drugs are 2.2 times more likely to request early dismissal or time off, 2.5 times more likely to have absences of eight days or more, and 3 times more likely to be late for work.9

■ Illicit drug users are more than twice as likely than those who do not use drugs to have changed employers three or more times in the past year.10

Substance abuse increases an employer’s medical costs.

■ Employees who use drugs cost their employers about twice as much in medical claims as do non-drug-using employees.11

What can your organization do to decrease the impact of substance abuse?

Implement a drug-free workplace program

In 1988, the Drug-free Workplace Act was passed, requiring all federal grantees and some recipients of federal contracts to agree to provide a drug-free workplace as a condition of receiving federal money.12 In a drug-free workplace, all employees adhere to a program of policies and activities designed to provide a safe Workplace. The policies and activities discour-age alcohol and drug abuse and encourage treatment, recovery and the return to work of those employees who have abuse problems.13

Even if your organization is not required to have a drug-free workplace program, your organization can still benefit.12

A successful drug-free workplace program may include:

■ a written policy■ employee education■ supervisor training■ access to assistance■ drug testing

A good drug-free workplace program can lead to

Decreases in: Increases in:

■ absenteeism ■ productivity■ accidents ■ profits■ downtime ■ customer satisfaction■ turnover ■ health status■ theft ■ employee morale■ workers’ compensation costs■ employee discipline problems

For more information about drug-free workplace programs, visit

http://www.drugabuse.gov/index.html

http://dwp.samhsa.gov

3

References

1 US Department of Health and Human Services Substance Abuse and Mental Health Services Administration. (2000). 1999 National Household Survey on Drug Abuse. Rockville, MD: US Department of Health and Human Services.

2 Website- http://www.uschamber.com/sb/screening/0512_quest6.htm3 Website- http://www.oas.samhsa.gov/occupation.htm4 US Department of Health and Human Services Substance Abuse and Mental Health Services

Administration. (1995). Substance Abuse and Mental Health Statistics Sourcebook. Rockville, MD: US Department of Health and Human Services.

5 Website- http://www.drugfreeworkplace.com/employees/americandrugproblem.htm6 Bernstein, M. and Mahoney, J. (1989). Management Perspectives on Alcoholism: The Employer’s

Stake in Alcoholism Treatment. Occupational Medicine, 4(2).7 US Department of Health and Human Services Substance Abuse and Mental Health Services

Administration. (2000). 1999 National Household Survey on Drug Abuse. Rockville, MD: US Department of Health and Human Services.

8 National Association of Treatment Providers. (1991). Treatment is the Answer: A White Paper on the Cost-Effectiveness of Alcoholism and Drug Dependency Treatment. Laguna Hills, CA: National Association of Treatment Providers.

9 US Department of Health and Human Services Substance Abuse and Mental Health Services Administration. (2000). 1999 National Household Survey on Drug Abuse. Rockville, MD: US Department of Health and Human Services.

10 US Department of Health and Human Services Substance Abuse and Mental Health Services Administration. (1999). Worker Drug Use and Workplace Policies and Programs: Results from the 1994 and 1997 NHSDA. Rockville, MD: US Department of Health and Human Services.

11 Website- http://www.drugabuse.gov/infofacts/workplace.html12 Website- http://workplace.samhsa.gov/WPWorkit/workitindex.html13 Website- http://workplace.samhsa.gov/DrugFreeWP/DefNPurpose.html

Top 12 Reasons Why a Good Drug-Free Workplace Program Goes Bad

Working Partners for an Alcohol- and Drug-Free Workplace U.S. Department of Labor www.dol.gov/workingpartners

1. The drug-free workplace program isn’t tied into the organization’s safety plan since it’s not required by OSHA regulations. Although not required under OSHA regulations, drug-free workplace programs add value to workplace safety and health plans, and, in fact, OSHA has come out in support of them, especially in high-hazard industries. Incorporating your drug-free workplace program into your overall safety plan makes good safety sense and sends a clear signal to workers that you’re serious about it. It is important to note that because programs are often overseen by an organization’s Human Resources function, effectively integrating them into safety plans may require connecting the right people and ensuring they understand the program’s impact on each other’s areas of responsibilities. 2. There is a policy on paper, but no one knows what it says. If no one knows what the policy says, the reality is that there is no drug-free workplace program. To change this, decision makers need to get the company back on track—by pulling the policy out of the draw, reviewing it to ensure its still timely, updating it if necessary, and distributing and explaining it to all employees and supervisors. Also discussed should be the impact of drug use on business and respective roles in complying with and enforcing the policy. Employees should have the opportunity to ask questions and be required to sign “acknowledgement of receipt forms.” Once the revised policy is implemented, it should be reviewed once a year. The U.S. Department of Labor’s Working Partners Web site (www.dol.gov/workingpartners) has a tool called the Drug-Free Workplace Advisor that can help in assessing the adequacy of a policy. 3. There is a belief that once a policy is implemented, it’s too late to change it. It’s important to implement and enforce policies in a consistent manner; however, they’re not written in stone. Like organizations themselves, programs will likely need to change over time to meet evolving needs. Enforcement must be consistent but can still afford employers flexibility in dealing with specific situations. Policies should be reviewed periodically to consider what is working and what is not, and when appropriate, changes should be made. For example, a policy may originally include a “one strike and you’re out” provision without any avenues for workers to seek help and return to work, but when a senior employee with hard-to-replace skills tests positive on a drug test and you’re tempted to make an exception, it’s time to revisit whether your policy meets your needs. 4. Workers feel drug testing is invasive and won’t go for it. While drug testing may seem invasive, it actually protects the company and contributes to every individual’s job security and personal safety. Education and employee involvement from the beginning is key to a successful program, and in fact, many unions support drug testing when implemented in a fair manner that includes procedures that ensure the integrity, accuracy and confidentiality of test results and provide opportunities for workers to get help and retain their jobs.

Top 12 Reasons Why a Good Drug-Free Workplace Program Goes Bad Page 2 of 4

But it takes more than a brochure or a poster on a bulletin board to help workers understand and appreciate that drug testing protects worker safety.

5. There is a belief that if applicants are drug tested, no one will ever be hired. If the level of drug use at your organization is that high, you’re already at risk for higher absenteeism and medical costs and lower productivity, in addition to serious liability. It’s a ticking time bomb if not properly addressed. What’s your exposure once the word gets out that “users” can get away with their behavior at your business? No company has ever gone out of business because it could not find drug-free applicants. Take a few minutes to understand how drug use costs businesses. Then, consider that most people do not use drugs and that all these people do not want to work next to someone who does. Promote that you are a drug-free workplace and drug testing is a condition of employment. Non-users will find you and appreciate the safety and security of staying on your payroll. 6. The policy includes reasonable suspicion testing, but supervisors never exercise it because they’re afraid of making a wrong call. Thoroughly training supervisors is key. They must understand and feel comfortable identifying the factors that constitute “reasonable suspicion” that a worker’s use of drugs or alcohol is affecting job performance. They should be reminded that a test is an objective indicator of recent use and can rule it out. It’s also a good idea to have sufficient checks and balances. When a supervisor recognizes the signs of drug or alcohol use because it’s affecting job performance, someone at a higher level should review the information and observations before making the final decision to require a drug test. 7. There is a belief that drug testing doesn’t really improve safety since it doesn’t show actual impairment. Drug testing is a good deterrent—most sensible people won’t risk their jobs if they know they can be tested at any time. And money spent preventing an incident from ever occurring is typically 10 times less than associated costs surrounding a drug or alcohol incident, not to mention the emotional impact an accident or injury—or worse—has on staff morale. Also, positive drug tests do show recent use and have become defacto evidence of impairment. Courts have upheld employer rights to take disciplinary action against employees who test positive—especially when safety is an issue. Drugs, whether illegal or prescription, are controlled precisely because of their effect on behavior and health. Furthermore, the nature of addiction creates safety concerns even when someone isn’t currently “under the influence” because of the edginess associated with drug cravings. It’s important to write drug-free workplace policies to prohibit workers from reporting to work with detectable levels of drugs in their system, not just “working under the influence.” 8. There is a belief that there’s no use testing since people can cheat the test. Good labs can beat the cheaters by testing for adulteration, substitution, specific gravity and other common ways that signal someone is trying to beat the test. Do not use a lab that does not provide this “value-added” testing. Ask the lab if it performs these tests. Then, ask for a letter stating that it performs these tests. Taking care to ensure the collection site is properly secured (e.g., bluing agent in toilet, water turned off) is another step. Observed collections are appropriate only when there is evidence of efforts to cheat.

Top 12 Reasons Why a Good Drug-Free Workplace Program Goes Bad Page 3 of 4

9. Only illicit drugs are tested for, but there are known problems with alcohol and prescription drugs. Only federal government-mandated programs are limited to testing for certain drugs, namely the “5-panel” test (cocaine, amphetamines, opiates, marijuana and PCP). Because of its significant impact on safety, the U.S. Department of Transportation regulations also include alcohol. Employers do have the right to know about the use of prescription drugs when it can impair performance and jeopardize safety, and many private-sector organizations do test for alcohol and prescription drugs. However, when this is the case, it is extremely important to ensure your drug-testing procedures include review by a Medical Review Officer (MRO) and allow workers the opportunity to provide a legitimate explanation for a positive test result, such as a physician’s prescription. You must be very clear about the role of the MRO in reviewing such cases and what avenue he/she has for reporting concerns if he/she feels even legitimate use of a drug could impair a person’s ability to work safely. In such cases, a change in duties or even a leave of absence might be appropriate. 10. Safety professionals don’t feel they have the expertise to provide training on drug issues. You don’t have to be an expert to educate your workforce about workplace drug abuse and the specifics on your drug-free workplace policy. The U.S. Department of Labor’s Working Partners Web site (www.dol.gov/workingpartners) includes supervisor and employee training presentations, tool box talks, facts sheets and supporting materials such as posters and data. There are also professionals that specialize in this type of training and, if you provide an Employee Assistance Program (EAP) as part of your drug-free workplace program, training is often included in the service. If you don’t have an EAP, you may be able to find specialized trainers through the Working Partners Web site’s state resource directory. Keep in mind that even if you use outside trainers, programs should be tailored to educate employees about the specifics of your organization’s policy and convey management’s commitment to ensuring its effectiveness. 11. Management believes offering Employee Assistance Program (EAP) services and treatment are luxuries it can’t afford. Actually, studies show that EAPs save organizations money. They decrease turnover, absenteeism and health care costs (including workers’ compensation claims) and increase productivity. They also help prevent drug and alcohol abuse and provide a way to intervene early, before someone gets caught on a drug test. In the event a test does come up positive, EAPs provide an avenue for assessment and referral. They also play a large role in treatment, which has been shown to be effective, allowing many valued, skilled employees to return to work safely and productively. In many cases, it is the EAP who helps the worker come to terms with the fact that he/she may have a problem and works with him/her to identify the best option for treatment based on insurance, availability, time and personal finances. Some employees have access to EAP services and don’t even know it –through insurance companies, which may offer them because they are aware of the savings that add up from a little prevention. It is important to note that EAPs may also minimize an employer’s legal vulnerability by demonstrating efforts to support employees.

12. Workers don’t trust EAPs. They think they’re just a management tool to get rid of problem employees. It should be reinforced to employees that EAPs are staffed by trained professionals who provide confidential services and work to make workplaces safer and more productive for the benefit of

Top 12 Reasons Why a Good Drug-Free Workplace Program Goes Bad Page 4 of 4

employees and employers alike. It is also important to educate EAP staff about the unique characteristics of each particular workplace. Also, since EAPs help both workers and management, finding the right EAP service provider should be a collaborative task. Once an EAP is implemented, it can be a lifeline for some employees by helping them address personal problems, including but not limited to alcohol and drug abuse, that are interfering at work or home. The main focus of an EAP is prevention, and employees should be reminded through regular communication that the best time to access EAP services is before a problem becomes a job risk. In cases when the EAP involvement comes too late, they still assist through appropriate assessment, referral and follow up.