HomeMy WebLinkAboutPolicy SummaryDrug -Free Work Place Policy Summary
Read carefully, ask any questions and initial each item separately.
I hereby acknowledge that I have received a summary of the Employer's Drug -Free Workplace Policy. I
have had the opportunity to read the Employer's Drug -Free Workplace program and receive satisfactory
answers to any questions that I have. I have also received a copy of the list of over-the-counter and
prescription drugs that could alter or affect the outcome of a drug test.
I know that if I am taking medicine that could affect my ability to perform my job (i.e., there are warning
labels on the container) I must inform my supervisor immediately.
I know that if I refuse to submit to a pre-employment drug test I will not be hired and my employment is
conditioned upon a negative drug test result.
I know that total compliance with the Employer's Drug -Free Workplace Policy is a condition of continued
employment.
I know that if I refuse a reasonable suspicion, post -injury, post accident, fitness -for -duty or post-treatment
drug or alcohol test I may lose my job. Also, I understand that my unemployment benefits, and my workers'
compensation medical and indemnity benefits may be denied.
I know that if I am injured, cause or contribute to the cause of an injury or an accident and test positive for
drugs or alcohol I will be subject to discipline up to and including discharge.
I know that if I enter into a treatment program for drug or alcohol abuse and test positive for drugs or
alcohol following the completion of the primary phase of my treatment I will be subject to discipline up to
and including discharge.
I know that I have the right to challenge any positive test result and that I must notify the laboratory and the
MRO that I am challenging the test result.
I know that if I am convicted of a drug related crime I must notify my supervisor within five working days.
I agree to comply with the drug and alcohol testing requirements of the Greater Miami Caterers Drug -Free
Workplace Policy.
I give my informed consent for the release of drug and/or alcohol test results, to the Greater Miami Caterers.
I know that the Employer's Drug -Free Workplace Policy does not constitute an employment contract
between the Greater Miami Caterers and me.
I have read and understood each of the preceding items that I have initialed. I have had the opportunity to
question any item that I did not understand. I have voluntarily signed this form.
Employee Date Witness Date
I hereby refuse to submit to a drug test as part of the Employer's. Drug -Free Workplace Program.
Employee Date Witness Date