1 Flagler College Athletic Department Alcohol, Tobacco and Drug Policy Reviewed and Revised May 2013
2 Table of Contents Introduction 3 Purpose of the Flagler College Institutional Drug Testing Program 3 Eligibility 3 Alcohol Statement 3 Tobacco Statement 3 Substance Testing 3 Dietary Supplement Statement 3 Types of Drug Testing 4 Selection of Individuals to be Tested 4 Notification of Individuals Selected and Reporting for Collections 4 Specimen Collection 5 Adulteration, Manipulation and Dilution of a Specimen 5 Notification of Results 5 Flagler College Institutional Drug Testing Program Sanctions 5 B Vial Testing 6 Appeals Process 6 Self-Disclosure (Safe Harbor) 6 NCAA Medical Exemptions Process 7 Appendices A NCAA Banned Classes List 8 B - Dietary Supplement Disclosure Form & Prescription/OTC Medication Notification Form 9 C - Urine Specimen Collection Protocol 11 D Notification Form 13 E - Reasonable Suspicion Notification Form 14 F - Follow-up Meeting Form 15
3 The Flagler College Athletic Department has a policy concerning the use of recreational, illegal and banned substances. This policy is enforced by the Flagler College Athletic Department, not the NCAA. This policy is not to be construed as a contract between Flagler College and the student athletes attending Flagler College. However, signed consent and notification forms shall be considered affirmance of the student athlete s agreement to the terms and conditions contained in this policy and shall be a legal contractual obligation of the student-athlete. The Head Athletic Trainer and Athletic Department Administrators are responsible for assuring all student-athletes adhere to this policy. Any studentathlete who tests positive for recreational, illegal or banned substances will be subject to sanctions specified in this policy and enforced by the Flagler College Athletic Department. Purpose of the Flagler College Institutional Drug Testing Program The central purpose of the Flagler College Institutional Drug Testing Program is to protect the student athlete from the detrimental effects of alcohol and drug use/abuse. This institutional drug testing program is meant to promote a campus environment free of the abuse of alcohol and the illegal use of alcohol and drugs. This program has also been developed to ensure that appropriate intervention will take place should drugs or illegal substances be detected during a random drug test. Other specific goals of the Flagler College Institutional Drug Testing Program include education of all student athletes and departmental staff in the dangers of alcohol and drug abuse, identifying individuals who may be involved in alcohol and drug use/abuse, deterring the use/abuse of alcohol and illegal drugs, development of a consistent set of sanctions set by the athletic department should a student athlete test positive for illegal drugs or substances, provide and implement a confidential treatment/rehabilitation protocol for those found to have used illegal drugs or substances, and promoting the positive role of Flagler College student-athletes in the college, local and competitive communities. Eligibility All current student athletes whose names are on a current squad list and/or are receiving athletic financial aid will be subject to drug testing. Alcohol The Flagler College Athletic Department does not tolerate illegal or irresponsible use of alcohol (including drinking while underage and purchasing alcohol for use by a minor). Any student athlete that is involved in an alcohol related incident will be held accountable for his/her actions. He or she will be subject to the college, athletic department, and team disciplinary actions whether or not legal implications result from the incident (including referral for counseling). If the student athlete is involved in an alcohol related incident that results in legal implications, he/she will be immediately suspended from any athletic related activities until the college disciplinary board (Student Services) has reviewed his/her case and enforced consequences deemed appropriate by the board. Tobacco The NCAA prohibits use of tobacco products by all student athletes, coaches, athletic trainers, managers and officials in all sports during practice and competition. The Flagler College Athletic Department prohibits the use of tobacco by student athletes, staff and spectators on the grounds of all athletic facilities at all times. Any Flagler College Athletic Department staff member or student athlete representing the college and/or athletic department in an official capacity at any time is prohibited from the use of tobacco products. Violators of this policy are subject to disciplinary actions deemed appropriate by the Athletic Director, Head Coach or Head Athletic Trainer. Substance Testing The Flagler College Institutional Drug Testing Program is separate from and in no way related to the NCAA Drug Testing Program. The Flagler College Institutional Drug Testing Program may test for substances not listed on the NCAA Banned Substances List and may test at different cut-off levels of banned substances than the NCAA. Prohibited substances include, but are not limited to amphetamine/methamphetamine, cocaine, marijuana, ecstasy (MDMA), oxycodone, methylphenidate (including Ritalin), ephedrine, alcohol, anabolic steroids and other performance-enhancing compounds. Questions regarding the legality of a specific substance should be directed to the Flagler College Athletic Training Staff. A student-athlete must provide signed physician documentation of prescription medications to the Flagler College Sports Medicine staff. If proper documentation is not provided prior to drug testing, a failed test will be considered positive. Ignorance of the legality of a substance is no excuse for a positive test! Dietary Supplements The Flagler College Athletic Department neither approves of nor condones the use of dietary supplements. The NCAA shares this view and has issued a position statement that reads as follows: Nutritional/dietary supplements may contain NCAA banned substances. The U.S. Food and Drug Administration (FDA) does not strictly regulate the supplement industry; therefore purity and safety of nutritional/dietary supplements cannot be guaranteed. Impure supplements may lead to a positive NCAA drug test. The use of supplements is at the
4 student athlete s own risk. Student athletes should contact their institution s team physician or athletic trainer for further information. Types of Drug Testing A team or individual may be tested at the request of the coach, team physician or administration. A team or individual may be tested at random, because of reasonable suspicion, for re-entry into participation or as a follow-up. Student athletes can be selected for testing during preseason, regular season, post season or at any time during the academic year. The types of/reasons for drug testing previously described are defined as follows: Random A pre-determined number of student-athletes from each intercollegiate athletic team will be randomly selected to participate in the Flagler College Institutional Drug Testing Program. Random drug screening tests will be administered throughout the academic year. Reasonable Suspicion Any student athlete participating in the Flagler College intercollegiate athletics program is subject to drug testing upon request if there is reasonable cause to believe that the student athlete may be using banned substances. Circumstances which constitute reasonable cause include, but are not limited to, the following: current or past involvement with the criminal justice system for drug related activities, notification from the Department of Student Services of any report that includes the presence of drugs and/or drug paraphernalia, prior treatment for drug problems, admission of a current drug problem, prior positive test for any banned substances, physiological signs of possible impairment from drugs, or a pattern of aberrant behavior. Re-entry Testing Any student athlete testing positive for an illegal substance will be subject to testing prior to release from administrative sanctions. The student athlete is responsible for the cost of the re-entry test. The cost of re-entry testing is $ ($ for the collector and $50.00 for the drug test). The full cost of the re-entry test will be collected by a member of the Flagler College Athletic Training Staff prior to scheduling of the re-entry test (the student-athlete must notify a staff athletic trainer of what day he/she wants to take his/her re-entry test no later than seven days prior to the day of the scheduled test). A member of the Athletic Training Staff will issue a receipt to the student athlete upon payment. This test must be negative prior to release. Follow up Testing Any athlete testing positive for an illegal substance will be subject to repeated random testing for the remainder of his/her Flagler College Athletics career from the time of the positive test. NCAA Year Round Program The NCAA reserves the right to test all sports in accordance with the Year Round Drug Testing Program. NCAA Championship In the event of an individual or team qualifying for NCAA Championship competition the individual or team is subject to drug testing prior to, during or post event by the NCAA. Selection of Individuals to be Tested The student athlete will be notified prior to any athletic participation as to the Flagler College Institutional Drug Testing Policy. At this time the student athlete will sign a consent form as to the procedures set forth in the Flagler College Institutional Drug Testing Policy. All student athletes will be subject to unannounced drug screenings throughout the academic year on a random, reasonable suspicion, re-entry or follow-up basis. Notification of Individuals Selected and Reporting for Collections: Advanced notice will not be given for Flagler College institutional drug testing. On the day that testing will take place, the Head Athletic Trainer, Assistant Athletic Trainer(s) and/or the Director of NCAA Compliance will contact selected student athletes by phone call, text message, or hand deliver a paper notification of selection to each selected studentathlete. At the time of the phone call/text message/presentation of the notification the student-athlete will be notified of the designated time and location of the drug test. Student athletes that are notified by phone call or text message will sign the notification form at the time they report for testing. At that time the student athlete will be escorted directly to the athletic training room for instructions. Drug testing will commonly be conducted in the Flagler College Gymnasium locker rooms. All selected individuals should bring a photo ID to the drug testing site. If the student athlete is notified at practice, the presenter of the notification will bring the student athlete to the athletic training room via a Flagler College van. The Head Athletic Trainer, an Assistant Athletic Trainer or the Director of NCAA Compliance will be the driver of the Flagler College van. If a notified student athlete fails to report to the drug testing session within 3 hours of
5 the specified start time, he/she will be considered to have a positive result and face sanctions as if his/her specimen tested positive. Specimen Collection: Flagler College reserves the right to test for banned drugs by any approved industry method. These methods may include but are not limited to oral fluid, sweat, urine or hair. Proper attire must be worn no hats, excessive clothing, backpacks or other items will be allowed to be worn into the testing facility. The actual specimen will be provided under direct observation assuring the integrity of the specimen. Urine specimen collection will be based on the National Center for Drug Fee Sport Urine Collection Protocol (see appendix C). The student athlete will not be allowed to leave the testing facility until he/she has given an acceptable specimen unless otherwise instructed by the Site Coordinator. Adulteration and Manipulation of a Specimen If a student athlete attempts to adulterate or manipulate a specimen the student-athlete will be suspended for 1 calendar year from the date the test results are received. Also, he/she will be subsequently retested prior to return to participation. Student athlete will be responsible for cost of re-entry test as stated above. Dilution of a Specimen If a student athlete gives a dilute specimen, the voiding process will continue until an adequate specimen is collected (measuring specific gravity and ph). If a student athlete gives three dilute specimens in a row his/her viable sample can be specifically tested for masking agents/diuretics/urine manipulators. Notification of Results The Head Athletic Trainer will receive all test results by . Paper copies of all results will be retained by the Head Athletic Trainer. Any student athlete that tests positive will be notified by the Head Athletic Trainer. Following notification of the student athlete, the Head Athletic Trainer will notify student athlete s Head Coach All faculty and staff members of Flagler College are expected to respect a student-athlete s right to privacy at all times. It is essential that anything seen, heard, read, and/or otherwise obtained remain confidential by all parties involved. It is illegal for any personnel to gain access to patient information, through any and all means, unless the information is needed in order to treat the patient, or because their job would require such access. Violation of confidentiality may incur disciplinary action at the discretion of the Athletic Director. Flagler College Institutional Drug Testing Program Sanctions Any student athlete who tests positive will face the following sanctions: First Positive Test Result 1. The athlete s head coach will meet with athletic department administrators (Athletic Director, Director of NCAA Compliance and Head Athletic Trainer) to clearly define the terms of suspension 2. Athlete will be required to meet with the Athletic Director, athletic department administrators and his/her Head Coach. The date and time of this meeting must be established within 48 hours of positive test result notification. This meeting must take place within 5 business days of the positive test result notification. 3. Parental notification by conference call during meeting referred to above and follow-up notification in writing (Parental notification will still occur if the 5 day window to schedule meeting is exceeded) 4. Referral for evaluation at the Flagler College Student Services Counseling Center 5. Suspension from all team activities for at least twenty calendar days 6. Suspension from at least twenty-five percent of competitions in regular season 7. Subjection to unannounced drug and alcohol screening at any time * A student athlete who tests positive has the option to take a re-entry test no earlier than fifteen days from the original test date. The student athlete will be suspended from all team activities for twenty days or until re-entry test results are received. If a student athlete fails the re-entry test the athlete has the option to take a second re-entry test fifteen days after results from the first re-entry test are received. If a student-athlete fails a second re-entry test the athlete will be permanently dismissed from all Flagler College Intercollegiate Athletics. The student athlete is responsible for the cost of any and all re-entry tests. Second Positive Test Result
6 1. Athlete will be required to meet with the Athletic Director, athletic department administrators and his/her Head Coach. The date and time of this meeting must be established within 48 hours of positive test result notification. This meeting must take place within 5 business days of the positive test result notification. 2. Parental notification by conference call during meeting referred to above and a follow up notification in writing (Parental notification will still occur if the 5 day window to schedule meeting is exceeded) 3. Reduction or cancellation of athletic scholarship (per the Flagler College Athletic Grant-In-Aid Agreement) 4. Permanent dismissal from all Flagler College Intercollegiate Athletics Refer to the following flow chart for scenarios: (F)=Failed Test (P)=Passed Test RST=Random Selection Test RET=Re-Entry Test Scenario 1: Scenario 2: Scenario 3: (F) 1 st RST (F) 1 st RET (F) 2 nd RET = Dismissal from Athletics (F) 1 st RST (P) 1 st RET (F) 2 nd RST = Dismissal from Athletics (F) 1 st RST (F) 1 st RET (P) 2 nd RET (F) 2 nd RST = Dismissal from Athletics If a student athlete refuses to adhere to any part of the sanction process, he/she forfeits the right to participate in any Flagler College Intercollegiate Athletic Program. B Vial Testing If a student athlete tests positive, he/she has the option to have the B vial tested at his/her expense. A request for the B vial to be tested must be submitted in writing to the Athletic Director within 72 hours of the notification of the positive result. The cost of the B vial test is approximately $50.00 and the student-athlete is responsible for payment prior to the B vial test. If the student athlete cannot afford to pay for the B vial test, the student-athlete will be billed by Student Services. If the B vial results are negative, the student athlete will be reimbursed the cost of the B vial test. If the B vial results are positive the Head Athletic Trainer will notify the student athlete and the student athlete will serve the remainder of the specified sanctions. Suspension days served during the B vial testing process will count as time served towards specified sanctions. Appeals Process Student athletes who test positive, or who dispute that they have refused or failed to take a required drug test, under the terms of the Flagler College Alcohol, Tobacco and Drug Policy will be entitled to a hearing with the Drug Testing Appeals Committee or his/her imposition of any sanction. Requests for such a hearing must be in writing (must state student athlete s name, contact information, date of drug test, date of results notification, date of appeal notice and reason for the appeal) received by the Athletic Director within seventy-two (72) hours of notification of a positive test result. If the seventy-two hours would end on a weekend, the request must be made by noon on the next business day. The Drug Testing Appeals Committee shall consist of the Athletic Director, NCAA Compliance Director, Faculty Athletic Representative and Associate Dean of Counseling. Other individuals may be needed to provide information, however these individuals will not have voting on the outcome of the appeal. These individuals may include but are not limited to the following: Drug Free Sport Representative / Scientist or designate, Flagler College Team Physician, Flagler College Sports Medicine Staff or Flagler College Coaches. The student athlete may have an advocate or other representative present at the hearing if the student so desires. However, the student athlete must present his or her own case. The meeting should take place no more than seventytwo (72) hours after the written request is received. All sanctions resulting in the positive test apply until the appeals process is finalized. Suspension days served during the appeals process will count as time served towards specified sanctions. These proceedings shall include an opportunity for the student athlete to present evidence, as well as to review the results of the drug test. The proceedings shall be open to only those persons deemed necessary by the Drug Testing Appeals Committee. Self-Disclosure (Safe Harbor) A student athlete eligible for the Flagler College Safe Harbor Program may refer himself or herself to the Safe Harbor Program for voluntary evaluation and counseling. A student athlete is not eligible for the Safe Harbor Program after he/she has been informed of an impending drug test or after having received a positive Flagler College Institutional or NCAA drug test. Flagler College will work with a student-athlete to prepare a Safe Harbor treatment plan, which may include confidential drug testing as determined by the Athletic Director, Associate Dean of Counseling, Team Physician and Athletic Trainer. If a student athlete tests positive for a banned substance upon entering the Safe Harbor Program, that positive test will not result in any administrative sanctions unless the student-athlete tests positive in a subsequent test or the student athlete fails to comply with the treatment plan. Based upon a medical examination by the team physician, the student
7 athlete may be disqualified from play or practice if medically indicated. The examination may consist of diagnostic tests to determine any potential risks the drug use poses to the student-athlete s welfare. A student will be permitted to remain in the Safe Harbor Program for a reasonable period of time, not to exceed thirty (30) days, as determined by the treatment plan. A student athlete will not be permitted to enter the Safe Harbor Program within thirty (30) days prior to NCAA or Conference postseason competition. If a student athlete tests positive for any banned substance after entering the Safe Harbor Program or fails to comply with the Safe Harbor treatment plan, the student will be removed from the Safe Harbor Program. An initial Safe Harbor positive test will be treated as a first positive and a subsequent positive as a second positive, subject to the sanctions explained in this policy. While in compliance with the Safe Harbor Program treatment plan, a student athlete will not be included in the list of students eligible for institutional drug testing by Flagler College. Student athletes in the Safe Harbor Program may be selected for drug testing by the NCAA. The NCAA Compliance Director, the Head Coach, the Head Athletic Trainer, and the Team Physician may be informed of a student-athlete s participation in the Safe Harbor Program. The Assistant Athletic Trainer assigned to that sport also may be notified, if medically appropriate. Assistant coach(es) may be informed at the discretion of the head coach. Other university employees may be informed only to the extent necessary for the implementation of this policy. Any student athlete that feels he or she may have a drug or alcohol problem is strongly encouraged to voluntarily seek assistance from a member of the Flagler College Athletic Department Staff or Student Services Counseling Staff. Medical Exemptions Process The NCAA as well as Flagler College recognizes that some banned substances are used for legitimate medical purposes. Accordingly, the NCAA and Flagler College allows exception to be made for those student athletes with a documented medical history demonstrating the need for regular use of such a drug. Exceptions may be granted for substances included in the following classes of banned drugs: anabolic agents*, stimulants, beta blockers, diuretics, anti-estrogens, and peptide hormone* (see subpart 2 below). The student-athlete is required to inform the Head Athletic Trainer or Team Physician of all medications he or she is taking. Procedures for Medical Exemption 1. Alternative non-banned medications for the treatment of various conditions exist and should be considered before an exception is pursued. 2. In the event that the student-athlete and the physician (in coordination with sports-medicine staff at the student athlete's institution) agree that no appropriate alternative medication to the use of the banned substance is available, the decision may be made to continue the use of the medication. However, the use of an *anabolic agent or peptide hormone must be approved by the NCAA before the student athlete is allowed to participate while taking these medications. The institution, through its director of athletics, may request an exception for use of an anabolic agent or peptide hormone by submitting to the NCAA medical documentation from the prescribing physician supporting the diagnosis and treatment. 3. The institution should maintain documentation that supports the use of medication in the student-athlete's medical record on campus. The documentation can be a letter or copies of medical notes from the prescribing physician that documents how the diagnosis was reached, and that the student-athlete has a medical history demonstrating the need for regular use of such a drug. The letter should contain information as to the diagnosis (including appropriate verification of the diagnosis), medical history and dosage information. 4. Unless requesting a review for the medical use of an anabolic agent or peptide hormone, a student athlete's medical records or physicians' letters should not be sent to the NCAA unless requested by the NCAA. Also, the use of the substance need not be reported at the time of NCAA drug testing. 5. In the event that a student athlete is tested by the NCAA and tests positive for a substance for which the institution desires an exception, normal procedures for reporting positive test results will be followed (See NCAA Drug-Testing Program Protocol Section No. 8.0). The institution, through its director of athletics, may request an exception at the time of notification of the positive drug test (A sample) by submitting to The National Center for Drug Free Sport the prescribing physician's letter and any other medical documentation demonstrating the need for regular use of the drug (see subpart 3 above) which the institution wishes to have the NCAA consider. A medical exception will be considered by the NCAA and the student-athlete will remain eligible during this time if the institution has provided medical documentation to Drug Free Sport before the "B" sample is reported as positive, confirming the positive finding. If the institution fails to provide medical documentation to Drug Free Sport before the "B" sample is reported as positive to the institution, the studentathlete will be withheld from competition until such time the documentation is received, reviewed and the medical exception granted.
8 6. Requests for exceptions will be reviewed by the chair of the drug-testing and drug-education subcommittee and the physicians of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. 7. Drug Free Sport will inform the director of athletics regarding the outcome of the exception request. In the event that the exception is not granted, the institution may appeal this action according to Section 8.0.of the drug-testing protocol. Appendix A Banned-Drug Classes NCAA Banned Drugs It is your responsibility to check with the appropriate or designated athletics staff before using any substance. The NCAA bans the following classes of drugs: a. Stimulants b. Anabolic Agents c. Alcohol and Beta Blockers (banned for rifle only) d. Diuretics and Other Masking Agents e. Street Drugs f. Peptide Hormones and Analogues g. Anti-estrogens h. Beta-2 Agonists Note: Any substance chemically related to these classes is also banned. The institution and the student-athlete shall be held accountable for all drugs within the banned drug class regardless of whether they have been specifically identified. Drugs and Procedures Subject to Restrictions: Blood Doping. Local Anesthetics (under some conditions). Manipulation of Urine Samples. Beta-2 Agonists permitted only by prescription and inhalation. Caffeine if concentrations in urine exceed 15 micrograms/ml. NCAA Nutritional/Dietary Supplements Warning: Before consuming any nutritional/dietary supplement product, review the product and its label with your athletics department staff! Dietary supplements are not well regulated and may cause a positive drug test result. Student-athletes have tested positive and lost their eligibility using dietary supplements. Many dietary supplements are contaminated with banned drugs not listed on the label. Any product containing a dietary supplement ingredient is taken at your own risk. Note to Student-Athletes: There is no complete list of banned substances. Do not rely on this list to rule out any supplement ingredient. Check with your athletics department staff prior to using a supplement. Some Examples of NCAA Banned Substances in Each Drug Class: Stimulants:
9 amphetamine (Adderall); caffeine (guarana); cocaine; ephedrine; fenfluramine (Fen); methamphetamine; methylphenidate (Ritalin); phentermine (Phen); synephrine (bitter orange); methylhexaneamine, bath salts (mephedrone) etc. exceptions: phenylephrine and pseudoephedrine are not banned. Anabolic Agents (sometimes listed as a chemical formula, such as 3,6,17-androstenetrione): boldenone; clenbuterol; DHEA (7-Keto); nandrolone; stanozolol; testosterone; methasterone; androstenedione; norandrostenedione; methandienone; etiocholanolone; trenbolone; etc. Alcohol and Beta Blockers (banned for rifle only): alcohol; atenolol; metoprolol; nadolol; pindolol; propranolol; timolol; etc. Diuretics (water pills) and Other Masking Agents: bumetanide; chlorothiazide; furosemide; hydrochlorothiazide; probenecid; spironolactone (canrenone); triameterene; trichlormethiazide; etc. Street Drugs: heroin; marijuana; tetrahydrocannabinol (THC); synthetic cannabinoids (eg. spice, K2, JWH-018, JWH-073) Peptide Hormones and Analogues: growth hormone(hgh); human chorionic gonadotropin (hcg); erythropoietin (EPO); etc. Anti-Estrogens : anastrozole; tamoxifen; formestane; 3,17-dioxo-etiochol-1,4,6-triene(ATD), etc. Beta-2 Agonists: bambuterol; formoterol; salbutamol; salmeterol; etc. Any substance that is chemically related to the class, even if it is not listed as an example, is also banned! Information about ingredients in medications and nutritional/dietary supplements can be obtained by contacting the Resource Exchange Center (REC) at 877/ or ww.drugfreesport.com/rec (password ncaa1, ncaa2 or ncaa3). Additional information can also be found at
10 Appendix B - Example Only, Do Not Complete Flagler College Sports Medicine Student Athlete Supplement Notification Form I understand and agree: (Print Name) Flagler College Department of Intercollegiate Athletics neither approves of nor condones the use of Supplements I have been informed of the Flagler College Department of Intercollegiate Athletics, National Collegiate Athletic Association (NCAA), and United States Olympic Committee (USOC) policies with regards to the use of Supplements, and have had any questions about these policies answered. The use of Supplements may result in serious harm to me, possible permanent injury to my health, and even death. I risk losing my eligibility to participate in intercollegiate athletics if I test positive for an NCAA banned substance I acknowledge that I am currently taking and/or have taken the following ergogenic aids, creatine powder, amino acids, protein supplements, or other similar substances, hereinafter referred to as Supplements. Use the back of this form if necessary: (If not taking a supplement print NONE) Name Dosage Main Ingredients Comments Example Only I fully accept any and all risks and liability if I have used in the past, continue to use, or use at any time in the future any form of Supplements. I further understand and agree that Flagler College, its officers, employees, and agents are not responsible for any harm and possible permanent injury to my health caused by my past, present, and/or future use of Supplements. I agree to hold harmless, indemnify, and irrevocably and unconditionally release the State of Florida, Flagler College, and their officers, employees and agents from any and all liability, and demands, claims and causes of action relating to my use of Supplements. I understand the statements in this form, and have had all questions about the information in this from answered to my satisfaction. Student Athlete Signature Parent or Guardian Signature / / Date / / Date
11 Appendix B - Example Only, Do Not Complete Flagler College Sports Medicine Prescription/OTC Medication Notification Form I understand and agree: (Print Name) I will provide Flagler College Sports Medicine with a current (within 1 year) prescription of medications I have been informed of the Flagler College Department of Intercollegiate Athletics, National Collegiate Athletic Association (NCAA), and United States Olympic Committee (USOC) policies with regards to the use of prescription/otc medication, and have had any questions about these policies answered. The use of prescription/otc medication other than in the manner directed may result in serious harm to me, possible permanent injury to my health, and even death. I risk losing my eligibility to participate in intercollegiate athletics if I test positive for an NCAA banned substance and have not given a signed physician document for my prescription. I acknowledge that I am currently taking and/or have taken the following prescription/otc medication within the past year. Use the back of this form if necessary: (If not taking a prescription/otc print NONE) Name Dosage Main Ingredients Reason Example Only I further understand and agree that Flagler College, its officers, employees, and agents are not responsible for I fully accept any and all risks and liability if I have used in the past, continue to use, or use at any time in the future any form of prescription/otc medications. any harm and possible permanent injury to my health caused by my past, present, and/or future use of prescription/otc medications. I agree to hold harmless, indemnify, and irrevocably and unconditionally release the State of Florida, Flagler College, and their officers, employees and agents from any and all liability, and demands, claims and causes of action relating to my use of prescription/otc medications. I understand the statements in this form, and have had all questions about the information in this from answered to my satisfaction. Student-Athlete Signature Parent or Guardian Signature / / Date / / Date Photocopies of this form are as binding as is the original and shall remain in effect until revoked in writing.
12 Appendix C Urine Specimen Collection Protocol 1. Upon entering the collection station, the athlete will provide photo identification and/or a Flagler College representative/site coordinator will identify the athlete and the athlete will be officially admitted into the collection station. 2. The athlete will select a sealed collection beaker from a supply of such and will record his/her initials on the collection beaker s lid or attach a unique bar code to the beaker. 3. A collector, serving as validator, will monitor the furnishing of the specimen by observation in order to assure the integrity of the specimen until a volume of at least 50 ml is provided (85 ml if testing for anabolic steroids). 4. Validators who are of the same gender as the athlete must observe the voiding process. The procedure does not allow for validators to stand outside the immediate area or outside the restroom. The athlete must urinate in full view of the validator (validator must observe flow of urine). The validator must request the athlete raise his/her shirt high enough to observe the midsection area completely to rule out any attempt to manipulate or substitute a sample. 5. Athletes may not carry any item other than his/her beaker into the restroom when providing a specimen. Any problem or concern should be brought to the attention of the collection crew chief for documentation. 6. Once a specimen is provided, the athlete is responsible for keeping the collection beaker closed and controlled until the specimen can be adequately processed and packaged for shipment to the laboratory. 7. Fluids and food given to athletes who have difficulty voiding must be from sealed containers (approved by the collector) that are opened and consumed in the station. These items must be caffeine- and alcohol-free and free of any other banned substances. 8. If the specimen is incomplete, the athlete must remain in the collection station until the sample is completed. During this period, the athlete is responsible for keeping the collection beaker closed and controlled. 9. If the specimen is incomplete and the athlete must leave the collection station for a reason approved by the collector, specimen must be discarded. 10. Upon return to the collection station, the athlete will begin the collection procedure again. 11. Once an adequate volume of the specimen is provided, the collector who monitored the furnishing of the specimen by observation will sign that the specimen was directly validated and a collector will check the specific gravity and if in range measure the ph of the urine in the presence of the student athlete. 12. If the urine has a specific gravity below (1.010 if measured with a reagent strip), the specimen will be discarded. The athlete must remain in the collection station until another specimen is provided. The athlete will provide another specimen. 13. If the urine has a ph greater than 7.5 (with reagent strip) or less than 4.5 (with reagent strip), the specimen will be discarded. The athlete must remain in the collection station until another specimen is provided. The athlete will provide another specimen. 14. If the urine has a specific gravity above (1.010 if measured with a reagent strip) and the urine has a ph between 4.5 and 7.5 inclusive, the specimen will be processed and sent to the laboratory. 15. The laboratory will make final determination of specimen adequacy. 16. If the laboratory determines that an athlete s specimen is inadequate for analysis, at the client s discretion, another specimen may be collected. 17. If an athlete is suspected of manipulating specimens (e.g., via dilution), Flagler College will have the authority to perform additional tests on the athlete.
13 18. Once a specimen has been provided that meets the on-site specific gravity and ph parameters, the athlete will select a specimen collection kit and a uniquely numbered Chain of Custody Form or set of Specimen Bar Code Seals from a supply of such. 19. A collector will record the specific gravity and ph values. 20. The collector will pour approximately 30 ml of the specimen into the A vial and the remaining amount (approximately 20 ml) into the B vial (A=60 ml, B=25 ml for anabolic steroid testing) in the presence of the athlete. 21. The collector will place the cap on each vial in the presence of the athlete; the collector will then seal each vial in the required manner under the observation of the athlete and witness (if present). 22. Vials and forms (if any) sent to the laboratory shall not contain the name of the athlete. 23. All sealed specimens will be secured in a shipping case. The collector will prepare the case for forwarding. 24. The athlete, collector and witness (if present) will sign certifying that the procedures were followed as described in the protocol. Any deviation from the procedures must be described and recorded. If deviations are alleged, the athlete will be required to provide another specimen. 25. After the collection has been completed, the specimens will be forwarded to the laboratory and copies of any forms forwarded to the designated persons. 26. The specimens become the property of the client. 27. If the athlete does not comply with the collection process, the collector will notify the client representative/site coordinator and third party administrator responsible for management of the drug-testing program.
14 Appendix D Example Only, Do Not Complete Flagler College Institutional Drug Testing Student Athlete Notification Form Student Athlete: Social Security No: Sport: Date of notification: Time of notification: a.m./p.m. I,, the undersigned acknowledge being notified to appear for (NAME) institutional drug and alcohol testing and have been notified to report to the drug and alcohol testing site at:, on at a.m./p.m. Example (location) (date) (time) I will be prepared to provide an adequate urine specimen and will not over hydrate. I understand that providing three diluted specimens may be cause for follow-up drug testing. I will be prepared to provide an adequate saliva sample if necessary and will not eat or drink at least 10 minutes prior to providing a saliva sample. I will be prepared to provide an adequate hair sample if necessary. I understand that failure to appear at the site on or before the designated time will result in a positive test result, therefore, I will face sanctions as Only if my specimen tested positive. By signing below, I acknowledge being notified of my participation in the Flagler College Institutional Drug Testing Program, and I am aware of what is required of me in preparation for this drug testing event. Student Athlete s Signature: Date: I can be reached at the following telephone number: Institutional Representative retain top portion of completed forms For Student Athlete Flagler College Institutional Drug Testing Program Student Athlete: Location of test: Date of test: Time to report: Report to the test site with picture identification. DO NOT DRINK TOO MANY FLUIDS.
15 Appendix E - Example Only, Do Not Complete Flagler College Institutional Drug Testing Reasonable Suspicion Notification Form I, under the reasonable suspicion clause that is (Flagler College Athletic Dept. Staff Member) outlined in the Flagler College Institutional Drug Testing Policy, report the following objective sign(s), symptom(s) or behavior(s) that I reasonably believe warrant be referred to the Department of (Name of Student Athlete) Athletics Drug and Alcohol Committee Chair or his/her designate for possible drug testing. The following sign(s), symptom(s) or behavior(s) were observed by me over the past hours and/or days. Please check below all that apply: The Student Athlete has shown: The Student Athlete has been: irritability late for practice loss of temper late for class poor motivation not attending class failure to follow directions receiving poor grades verbal outburst (e.g. to faculty, staff, teammates) staying up too late physical outburst (e.g. throwing equipment) missing appointments emotional outburst (e.g. crying) missing/skipping meals weight gain weight loss sloppy hygiene and/or appearance The Student Athlete has demonstrated the following: dilated pupils constricted pupils red eyes smell of alcohol smell of marijuana excessive talking staggering or difficulty walking periods of memory loss constantly running and/or red nose overstimulated or hyper recurrent bouts with a cold or the flu (give dates ) slurred speech withdrawn and/or less communicative recurrent motor vehicle accidents and/or violations (give dates ) recurrent violations of <School Name> Student Code of Conduct Other specific objective findings include: Example Only Print Name of Athletic Dept. Staff Signature of Athletic Dept. Staff Date Reviewed By: Athletic Director Date Photocopies of this form are as binding as is the original and shall remain in effect until revoked in writing.
16 Appendix F - Example Only, Do Not Complete Flagler College Institutional Drug Testing Follow Up Meeting Form Student Athlete: Date: Violation # (1, 2, 3) Test Date: Witnesses: Student Informed of Current Penalties: Student Informed of Future Example Penalties: Student Athlete Comments: Follow-up: Only Appeal Declaration Yes / No Student Athlete Signature: Witness: Witness: Date: Date: Date: Photocopies of this form are as binding as is the original and shall remain in effect until revoked in writing.
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