403 - Employee Health and Well Being
403 - Employee Health and Well Being dawn.gibson.cm… Wed, 07/06/2022 - 09:37403.1 - Employee Physical Examinations
403.1 - Employee Physical ExaminationsEmployees will be required to submit to a pre-employment physical examination after an offer of employment has been made and before the beginning of service. The school district will provide the standard examination form to be completed by an appropriately licensed health care provider who performs the physical examination. A written report of the physical examination shall be submitted to the school district. The date by which any such physical examination report shall be submitted to the school district shall be determined by the superintendent, but in no case shall be any less than five (5) business days prior to the first working day.
Bus drivers will be examined using all applicable state and federal criteria at the beginning of employment and every two years thereafter.
The cost of the initial examination will be paid by the employee.
Fitness-for-duty examinations may be required following an absence from work due to illness, if there is a reasonable belief that the employee is unable to perform the essential functions of the job or if there is a reasonable belief that the employee poses a direct threat to the employee or others because of a health condition. A direct threat occurs when an individual poses a significant risk of substantial harm to himself/herself or others and the risk cannot be reduced below the direct threat level through reasonable accommodations.
All information regarding the medical condition or history of an employee must be kept in files separate from the employee’s personnel records and treated as a confidential medical record subject to state and federal confidentiality laws.
The school district will provide an examination form to be completed by the personal physician of the employee. The school district also reserves the right to request additional physical or mental evaluation as deemed by a licensed physician for job performance.
Approved:
Reviewed: 12-09-12, 10-10-05, 12-15-08, 03-12-12, 12/14/16
Revised: 04-10-04, 01-17-12, 2-16-22
403.2 - Employee Injury on the Job
403.2 - Employee Injury on the JobWhen an employee becomes injured on the job, the building principal or designee shall notify a member of the family, or an individual of close relationship, as soon as the building principal and medical personnel become aware of the injury.
The school district is not responsible for medical treatment of an injured employee. If possible, an employee may administer emergency or minor first aid. An injured employee shall be turned over to the care of the employee's family or qualified medical employees as quickly as possible.
It shall be the responsibility of the employee injured on the job to inform the superintendent or human resources within twenty four hours of the occurrence. It shall be the responsibility of the employee or the employee's supervisor to file an accident report within twenty-four hours after the employee reported the injury.
It shall be the responsibility of the employee to file claims, such as worker's compensation, through the board secretary.
Approved: 07-1-92
Reviewed: 11-14-94 11-11-97, 12-11-99, 10-14-02, 10-10-05, 12-15-08, 01-17-12, 05-15-12, 12/14/16
Revised: 2-16-22
403.3 - Communicable Diseases - Employees
403.3 - Communicable Diseases - EmployeesSome employees with a communicable disease, as defined by law, will be allowed to attend to their customary employment duties without creating a risk of transmission of the illness to students or other employees. The school district also recognizes that there may be a greater risk of transmission of some communicable diseases for some employees with certain conditions than for other employees infected with the same disease.
Employees with a communicable disease will be allowed to perform their customary employment duties provided they are able to perform the essential functions of their position and their presence does not create a substantial risk of illness or transmission to students or other employees. The term communicable disease shall mean an infection or contagious disease spread from person to person or animal to person or as defined by law. A direct threat occurs when an individual poses a significant risk of substantial harm to himself/herself or others and the risk cannot be reduced below the direct threat level through reasonable accommodations.
An employee who is at work and who has a communicable disease that poses a direct threat, as defined above, shall report the condition to the superintendent any time the employee is aware that the employee’s condition poses a direct threat. Any individual who has information that a school district employee may have a communicable disease is encouraged to report the information to the superintendent.
Prevention and control of communicable diseases shall be included in the school district's bloodborne pathogens exposure control plan. The procedures shall include scope and application, definitions, exposure control, methods of compliance, universal precautions, vaccination, post-exposure evaluation, follow-up, communication of hazards to employees, and record keeping. This plan shall be reviewed annually by the superintendent and school nurse.
The superintendent shall determine on a case-by-case basis whether the presence of an employee with a communicable disease in the school district environment constitutes a direct threat. In making this determination, the superintendent shall consider credible, objective evidence. If the superintendent, after reviewing the credible, objective evidence, determines the employee’s presence may constitute a direct threat, the superintendent may request additional medical information from the employee’s physician with the employee’s consent, a physician chosen by the school district or public health officials, to confirm the superintendent’s determination.
The health risk to immunodepressed employees shall be determined by their personal physician. The health risk to others in the school district environment from the presence of an employee with a communicable disease shall be determined on a case-by-case basis by the employee's personal physician, a physician chosen by the school district or public health officials.
Approved: 11-14-94
Reviewed: 7-11-95, 10-14-02, 10-10-05, 12-15-08, 03-12-12, 12/14/16
Revised: 11-11-97, 2-16-22
403.3R1 - Universal Precautions Regulation
403.3R1 - Universal Precautions RegulationUniversal precautions (UP) are intended to prevent transmission of infection, as well as decrease the risk of exposure for employees and students. It is not currently possible to identify all infected individuals, thus precautions must be used with every individual. UP pertain to blood and other, potentially infectious materials (OPIM) containing blood. These precautions do not apply to other body fluids and wastes (OBFW such as saliva, sputum, feces, tears, nasal secretions, vomitus and urine unless blood is visible in the material. However, these OBFW can be sources of other infections and should be handled as if they are infectious. The single most important step in preventing exposure to and transmission of any infection is anticipating potential contact with infectious materials in routine as well as emergency situations. Based on the type of possible contact, employees and students should be prepared to use the appropriate precautions prior to the contact. Diligent and proper hand washing, the use of barriers, appropriate disposal of waste products and needles, and proper decontamination of spills are essential techniques of infection control. All individuals should respond to situations practicing UP followed by the activation of the school response team plan. Using common sense in the application of these measures will enhance protection of employees and students.
Hand Washing
Proper hand washing is crucial to preventing the spread of infection. Textured jewelry on the hands or wrists should be removed prior to washing and kept off until completion of the procedure and the hands are rewashed. Use of running water, lathering with soap and using friction to clean all hand surfaces is key. Rinse well with running water and dry hands with paper towels.
- Hands should be washed before physical contact with individuals and after contact is completed.
- Hands should be washed after contact with any used equipment.
- If hands (or other skin) come into contact with blood or body fluids, hands should be washed immediately before touching anything else.
- Hands should be washed whether gloves are worn or not and, if gloves are worn, after the gloves are removed.
Barriers
Barriers anticipated to be used at school include disposable gloves, absorbent materials, and resuscitation devices. Their use is intended to reduce the risk of contact with blood and body fluids as well as to control the spread of infectious agents from individual to individual. Gloves should be worn when in contact with blood, OPIM or OBFW. Gloves should be removed without touching the outside and disposed of after each use.
Disposal of Waste
Blood, OPIM, OBFW, used gloves, barriers, and absorbent materials should be placed in a plastic bag and disposed of in the usual procedure. When the blood or OPIM is liquid, semi-liquid or caked with dried blood, it is not absorbed in materials, and is capable of releasing the substance if compressed, special disposal as regulated waste is required. A band-aid, towel, sanitary napkin or other absorbed waste that does not have the potential of releasing the waste if compressed would not be considered regulated waste. It is anticipated schools would only have regulated waste in the case of a severe incident. Needles, syringes, and other sharp disposable objects should be placed in special puncture-proof containers and disposed of as regulated waste. Bodily wastes such as urine, vomitus or feces should be disposed of in the sanitary sewer system.
Clean up
Spills of blood and OPIM should be cleaned up immediately. The employee should:
- Wear gloves.
- Clean up the spill with paper towels or other absorbent material.
- Use a solution of one part household bleach to one hundred parts of water (1:100) or other EPA-approved disinfectant and use it to wash the area well.
- Dispose of gloves, soiled towels, and other waste in a plastic bag.
- Clean and disinfect reusable supplies and equipment.
Laundry
Laundry with blood or OPIM should be handled as little as possible with a minimum of agitation. It should be bagged at the location. If it has the potential of releasing the substance when compacted, regulated waste guidelines should be followed. Employees who have contact with this laundry should wear protective barriers.
Exposure
An exposure to blood or OPIM through contact with broken skin, mucous membrane or by needle or sharp stick requires immediate washing, reporting, and follow-up.
• Always wash the exposed area immediately with soap and water.
• If a mucous membrane splash (eye or mouth) or exposure of broken skin occurs, irrigate or wash the area thoroughly.
• If a cut or needle stick injury occurs, wash the area thoroughly with soap and water.
The exposure should be reported immediately, the parent or guardian is notified, and the person exposed contacts a physician for further health care.
403.4 - Hazardous Chemical Disclosure
403.4 - Hazardous Chemical DisclosureThe board authorizes the development of a comprehensive hazardous chemical communication program for the school district to disseminate information about hazardous chemicals in the workplace.
Each employee shall annually review information about hazardous substances in the workplace. When an employee is hired or transferred to a new position or work site, the information and training, if necessary, shall be included in the employees’ orientation. When an additional hazardous substance enters the workplace, information about it shall be distributed to all employees and training shall be conducted for the appropriate employees. The superintendent shall maintain a file indicating which hazardous substances are present in the workplace and when training and information sessions take place.
Employees who will be instructing or otherwise working with students shall disseminate information about the hazardous chemicals with which they will be working as part of the instructional program.
Approved: 07-01-92
Reviewed: 11-14-94, 11-11-97, 10-11-99, 10-14-02, 10-10-05, 12-15-08, 03-12-12, 12/14/16
Revised: 2-16-22
403.5 - Harassment
403.5 - HarassmentHarassment of or by school district employees will not be tolerated in the school district. School district includes school district facilities, school district premises, and non-school district property if the employee is at any school district sponsored, school district approved or school district related activity or function, such as field trips or athletic events where the employee is engaged in school district business.
Harassment includes, but is not limited to that based upon perceived or actual race, color, creed, sex, national origin, religion, age, sexual orientation, gender identity or disability. Harassment by board members, administrators, employees, parents, vendors, and others doing business with the school district is prohibited. Employees whose behavior is alleged to be in violation of this policy will be subject to the investigation procedure which may result in discipline, up to and including, termination or other appropriate action. Other individuals whose behavior is alleged to be in violation of this policy will be subject to appropriate sanctions as determined and imposed by the superintendent or board.
Sexual harassment shall include, but not be limited to, unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when:
- submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment;
- submission to or rejection of such conduct by an individual is used as a basis for employment decisions affecting such individual; or
- such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile, or offensive working environment.
Other types of harassment may include, but not be limited to, jokes, stories, pictures or objects that are offensive, tend to alarm, annoy, abuse or demean certain protected individuals and groups.
Employees who believe they have suffered harassment shall report such matters to the investigator for harassment complaints. However, claims regarding harassment may also be reported to the alternate investigator for harassment complaints.
Upon receiving a complaint, the investigator will confer with the complainant to obtain an understanding and a statement of the facts. It is the responsibility of the investigator to promptly and reasonably investigate claims of harassment and to pass the findings on to the superintendent who will complete such further investigation as deemed necessary and take such final action as deemed appropriate. Information regarding an investigation of harassment is confidential to the extent possible, and those individuals who are involved in the investigation will not discuss information regarding the complaint outside the investigation process.
No one will retaliate against an employee or student because they have filed a harassment complaint, assisted or participated in a harassment investigation, proceeding, or hearing regarding a harassment charge or because they have opposed language or conduct that violates this policy.
It is the responsibility of the board members, administrators, licensed and classified employees, and others having business or other contact with the school district to act appropriately under this policy. It is the responsibility of the superintendent and investigator to inform and educate employees and others involved with the school district about harassment and the school district's policy prohibiting harassment.
This policy and accompanying regulations will only apply when an employee is the victim of an alleged harasser or an employee is the alleged harasser.
Approved: 7-1-92
Reviewed: 10-11-99, 10-14-02, 1-10-05, 12-15-08, 03-12-12, 12/14/16
Revised: 12-13-99, 2-16-22
403.5E1 - Harassment Complaint Form
403.5E1 - Harassment Complaint FormName of complainant: __________________________________________________________
Position of complainant: ________________________________________________________
Date of complaint: _____________________________________________________________
Name of alleged harasser: ________________________________________________________
Date and place of incident or incidents: _____________________________________________
______________________________________________________________________________
Description of misconduct: _______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name of witnesses (if any): ______________________________________________________
______________________________________________________________________________
_______________________________________________________________________________
Evidence of harassment, i.e., letters, photos, etc. (attach evidence if possible): ________________
_______________________________________________________________________________
Any other information: ___________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I agree that all of the- information on this form is accurate and true to the best of my knowledge.
Signature: ____________________________
Date: _______________________________
403.5E2 - Witness Disclosure Form
403.5E2 - Witness Disclosure FormName of witness: _________________________________________________________
Position of witness: _______________________________________________________
Date of testimony, interview: ________________________________________________
Description of instance witnessed: ____________________________________________
_________________________________________________________________________
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Any other information: _______________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Signature: ___________________________________
Date: _______________________________________
403.5R1 - Harassment Investigation Procedures
403.5R1 - Harassment Investigation ProceduresCOMPLAINT PROCEDURE
An employee who believes that they have been harassed shall notify the administrator that is not the immediate supervisor, the designated investigator. The alternate investigator is the building administrator that is the immediate supervisor. The investigator may request that the employee complete the harassment complaint form and turn over evidence of the harassment, including, but not limited to, letters, tapes or pictures Information received during the investigation shall be kept confidential to the extent possible. The investigator with the approval of the superintendent or the superintendent has the authority to initiate a harassment investigation in the absence of a written complaint.
INVESTIGATION PROCEDURE
The investigator shall reasonably and promptly commence the investigation upon receipt-of the complaint. The investigator shall interview the complainant and the alleged harasser. The alleged harasser may file a written statement refuting or explaining the behavior outlined in the complaint. The investigator may also interview witnesses as deemed appropriate. Upon completion of the investigation, the investigator shall report to the superintendent. The investigator will outline the findings of the investigation to the superintendent.
RESOLUTION OF THE COMPLAINT
The superintendent will complete the next step in the investigation reasonably and promptly upon receipt of the investigator's report. Following the investigators report, the superintendent may investigate further, if deemed necessary, and make a determination of the appropriate next step which may include discipline up to and including termination or other appropriate sanctions. Prior to the determination of the appropriate remedial action, the superintendent may, at the superintendent's discretion, interview the complainant and the alleged harasser. The superintendent shall file a written report closing the case. The complainant, the alleged harasser, and the investigator shall receive notice as to the conclusion of the investigation.
POINTS TO REMEMBER IN THE INVESTIGATION
• Evidence uncovered in the investigation is confidential.
• Complaints must be taken seriously and investigated.
• No retaliation will be taken against individuals involved in the investigation process.
• Retaliators will be disciplined up to and including termination or receive other appropriate sanctions.
CONFLICTS
If the investigator is the alleged harasser or a witness to the incident the alternate investigator shall be the investigator. If the alleged harasser is the superintendent, the alternate investigator shall take the superintendent's place in the investigation process. The alternate investigator shall report the findings to the board.
403.6 - Substance-Free Workplace
403.6 - Substance-Free WorkplaceThe board expects the school district and its employees to remain substance free. No employee shall unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbituate, marijuana or any other controlled substance or alcoholic beverage as defined by federal or state law. Workplace includes school district facilities, school district premises or school district vehicles. Workplace also includes non-school district property if the employee is at any school district sponsored, school district approved or school district related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school district business.
If an employee is convicted of a violation of any criminal alcohol or drug offense in any setting, the employee shall notify the employee's supervisor of the conviction within five days of the conviction.
The superintendent will make the determination whether to require the employee to undergo substance abuse treatment or to discipline the employee. An employee who violates the terms of this policy may be subject to discipline up to and including termination. An employee who violates this policy may be required to successfully participate in a substance abuse treatment program approved by the board. If the employee fails to successfully participate in a program, the employee may be subject to discipline up to and including termination.
The superintendent shall be responsible for publication and dissemination of this policy to each employee. In addition, the superintendent shall oversee the establishment of a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment programs.
Approved: 7-1-92
Reviewed: 11-14-94, 11-11-97, 10-11-99, 10-14-02, 10-10-05, 12-15-08, 03-12-12, 12/14/16
Revised: 2-16-22
403.6E1 - Substance Free Workplace Notice to Employees and Acknowledgement Form
403.6E1 - Substance Free Workplace Notice to Employees and Acknowledgement FormEMPLOYEES ARE HEREBY NOTIFIED it is a violation of the Substance-Free Workplace policy for an employee to unlawfully manufacture, distribute, dispense, possess, use or be under the influence of in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbituate, marijuana or any other controlled substance or alcohol, as defined in federal and/or state law.
Workplace is defined as the site for the performance of work done in the capacity as an employee. This includes school district facilities, other school district premises or school district vehicles. Workplace also includes non-school district property if the employee is at any school district sponsored, school district approved or school district related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school district business.
Employees who violate the terms of the substance-free workplace policy may be required to successfully participate in a substance abuse treatment program approved by the board. The superintendent retains the discretion to discipline an employee for violation of the substance-free workplace policy. If the employee fails to successfully participate in such a program the employee shall be subject to discipline up to and including termination.
EMPLOYEES ARE FURTHER NOTIFIED it is a condition of their continued employment that they comply with the above policy of the school district and will notify their supervisor of their conviction of any criminal alcohol or drug offense in any setting , no later than five days after the conviction.
SUBSTANCE-FREE WORKPLACE ACKNOWLEDGMENT FORM
I, ___________________________, have read and understand the substance-free workplace policy. I understand that if I violate the substance-free workplace policy, I may be subject to discipline up to and including termination or I may be required to participate in a substance abuse treatment program. I understand that if I am required to participate in a substance abuse treatment program and if I fail to successfully participate in a substance abuse treatment program or I refuse to participate, I understand I may be subject to discipline up to and including termination. I also understand that if I am convicted of a criminal alcohol or drug offense in any setting, I must report that conviction to my supervisor within five days of the conviction.
_______________________________________ ___________________________
(Signature of Employee) (Date)
403.6R1 - Substance Free Work Place Regulation
403.6R1 - Substance Free Work Place RegulationIf the superintendent suspects an employee bas a substance abuse problem, the superintendent shall follow these procedures:
- Identification - the superintendent shall document the evidence the superintendent has which leads the superintendent to conclude the employee bas violated the substance-free workplace policy. After the superintendent has determined there has been a violation of the substance-free workplace policy, the superintendent shall discuss the problem with the employee.
- Discipline - if, after the discussion with the employee, the superintendent determines there has been a violation of the substance-free workplace policy, the superintendent may recommend discipline up to and including termination or may recommend the employee seek substance abuse treatment. Participation in a substance abuse treatment program is voluntary.
- Failure to participate in referral - if the employee refuses to participate in a substance abuse treatment program or if the employee does not successfully complete a substance abuse treatment program, the employee may be subject to discipline up to and including termination.
- Conviction - if an employee is convicted of a criminal alcohol or drug offense in any setting, the employee must notify the employer of the conviction within five days of the conviction.
403.7 - Drug and Alcohol Testing Program
403.7 - Drug and Alcohol Testing ProgramEmployees who operate school district vehicles are subject to drug and alcohol testing if a commercial driver's license is required to operate the school district vehicle and the school district vehicle transports sixteen or more persons including the driver or the school district vehicle weighs twenty-six thousand one pounds or more. For purposes of the drug and alcohol testing program, the term employees includes applicants who have been offered a position to operate a school district vehicle.
The employees operating a school district vehicle as described above are subject to pre-employment drug testing and random, reasonable suspicion, and post-accident drug and alcohol testing. Employees operating school district vehicles will not perform a safety sensitive function within four hours of using alcohol. Employees governed by this policy are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate school district vehicles and continue to be subject to the drug and alcohol testing program as long as they may be required to perform a safety-sensitive function. Employees with questions about the drug and alcohol testing program may contact the school district contact person, the Superintendent, at 1505 Washington Street, PO Box 159, Ruthven, Iowa 51358.
Employees who violate the terms of this policy are subject to discipline up to and including termination. Employees who violate this policy may be required to successfully participate in a substance abuse evaluation and, if recommended, a substance abuse treatment program at their sole cost and expense, as a condition of continued employment. Employees who fail to or refuse to participate may be subject to discipline up to and including termination.
The superintendent will inform applicants of the requirement for drug and alcohol testing in notices or advertisements for employment. The superintendent will also be responsible for publication and dissemination of this policy and forms to employees operating school district vehicles. The superintendent will oversee a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment resources and programs.
Approved: 8-11-03
Reviewed: 10-10-05, 12-15-08, 03-12-12, 12/14/16
Revised: 04-13-05, 2-16-22
403.7E1 - Drug and Alcohol Testing Program Notice To Employees
403.7E1 - Drug and Alcohol Testing Program Notice To EmployeesEMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE HEREBY NOTIFIED they are subject to the school district's drug and alcohol testing program for pre-employment drug testing and random, reasonable suspicion, and post-accident drug and alcohol testing as outlined in the drug and alcohol testing program policy, its supporting documents, and the law.
Employees who operate school district vehicles are subject to drug and alcohol testing if a commercial driver's license is required to operate the school district vehicle and the school district vehicle transports sixteen or more persons including the driver or the school district vehicle weighs twenty-six thousand pounds or more. For purposes of the drug and alcohol-testing program, employees also include applicants who have been offered a position to operate a school district vehicle. The employees operating a school district vehicle are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate a school district vehicle and continue to be subject to the drug and alcohol-testing program.
It is the responsibility of the superintendent to inform employees of the drug and alcohol testing program requirements. Employees with questions regarding the drug and alcohol testing requirements will contact the school district contact person.
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that employees violating this policy, its supporting documents or the law may be subject to discipline up to and including termination or offered the opportunity to participate in counselling as a condition of continued employment. If offered, as a condition of continued employment, employees violating this policy, its supporting documents, regulations or the law bear the personal and financial responsibility to successfully participate in a substance abuse evaluation and a substance abuse treatment program recommended by the substance abuse professional. Employees who are required to participate in and who fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program will be subject to discipline up to and including termination.
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED it is a condition of their continued employment to comply with the drug and alcohol testing program policy, its supporting documents, and the law. It is a condition of continued employment for employees operating a school district vehicle to notify their supervisor of any prescription medication they are using. Drug and alcohol testing records about a driver are confidential and are released in accordance with this policy, its supporting documents, and the law.
EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE HEREBY NOTIFIED they are subject to the school district's drug and alcohol testing program for pre-employment drug testing and random, reasonable suspicion, post-accident, return-to-duty, and follow-up drug and alcohol testing as outlined in the drug and alcohol testing program policy, its supporting documents, and the law.
Approved:
Reviewed: 12-15-18, 03-12-12, 12/14/16
Revised: 04-13-05, 2-16-22
403.7E2 - Drug and Alcohol Testing Program Acknowledgement Form
403.7E2 - Drug and Alcohol Testing Program Acknowledgement FormI, ___________________________________ (Name of Employee), have received a copy, read, and understand the drug and alcohol testing program policy and its supporting documents. I consent to submit to the drug and alcohol testing program as required by the drug and alcohol testing program policy, its supporting documents, and the law.
I understand that if I violate the drug and alcohol testing program policy, its supporting documents or the law, I may be subject to discipline up to and including termination or I may be required to successfully participate in a substance abuse evaluation and a substance abuse treatment program, if recommended by the substance abuse professional. If I am required to and fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program, I understand I may be subject to discipline up to and including termination.
Furthermore, I know and understand that I am required to submit to a controlled substance test, the results of which must be received by this employer before being employed by the school district and before being allowed to perform a safety-sensitive function. I also understand that if the results of the pre-employment test are positive, that I will not be considered further for employment with the school district.
I also understand that I must inform my supervisor of any prescription medication I use. I further understand that drug and alcohol testing records about me are confidential and may be released in accordance with this policy, its supporting documents or the law.
______________________________________________ ______________________
Signature of Employee Date
403.7E3 - Drug and Alcohol Testing Program Pre-Employment Drug Test Acknowledgement Form
403.7E3 - Drug and Alcohol Testing Program Pre-Employment Drug Test Acknowledgement FormI, (name of applicant), have been informed of the requirement to submit to a drug test prior to being employed by the school district to perform a safety-sensitive function. I consent to submit to the drug and alcohol testing program as required by the drug and alcohol testing program policy, its supporting documents and the law.
I understand that the results of my drug test will be shared with the school district. I also understand that if I have a positive drug test result, I will not be considered further for employment with the school district.
I further understand that the drug and alcohol testing records and information about me is confidential, and may be released at my request or in accordance with the law.
____________________________________________ ________________________
(Signature of Applicant) (Date)