Department of Athletics Institutional Drug Education and Testing Program Policy

Transcription

1 Department of Athletics Institutional Drug Education and Testing Program Policy Overview This policy is not to be construed as a contract between the institution and the student-athletes at Daemen College. However, signed consent and notification forms shall be considered affirmation of the student-athlete s agreement to the terms and conditions contained in this policy. Daemen College reserves the right to amend this policy at any time. This drug-testing program described herein is separate and distinct from the NCAA Drug-Testing Program or any other drugtesting program. Purpose The Department of Athletics understands that the use, abuse and misuse of legal and illegal drugs pose a threat to the health, safety and welfare of student-athletes. The Institutional Drug Education and Testing Program Policy is intended to foster a drug-free environment for all participating intercollegiate student-athletes at Daemen College. The goals of the program are: To educate student-athletes and Department of Athletics personnel on the harmful effects that prohibited drug/banned substance use and/or abuse can have on their well-being and athletic performance. To protect the health, safety and welfare of the student-athlete. To deter student-athletes from engaging in the use of prohibited drugs/banned substances. To identify and assist student-athletes with treatment for substance use and/or abuse problems. To maintain the integrity of Daemen College, the Athletics Department and the East Coast Conference (ECC), and the National Collegiate Athletic Association (NCAA). Drug Educational Program At the beginning of each academic year (or a preseason team meeting) and at the beginning of the second semester (for new student-athletes), the Director of Sports Medicine or designee will give a presentation to explain the Institutional Drug Education and Testing Program Policy to studentathletes and Athletics Department personnel. A copy of the policy will be provided to each student-athlete and they will be asked to sign a consent form (see Appendix H) acknowledging receipt of the policy, their responsibly as a student-athlete to adhere to the policy and their agreement to participate in the testing program. 1 Rev. July 20, 2015

2 The individual College policies for prohibited drugs/banned substances, alcohol and tobacco will be reviewed and discussed. The specific College policies are outlined below and can be found in the Student Handbook and in the Student-Athlete Code of Conduct. The NCAA Banned Drug List (see appendix A) will also be reviewed including the banned drug classes and common banned substances. Time will be allowed for questions; in addition, student-athlete s wishing to discuss any parts of this policy in a more confidential setting will be instructed to make an appointment with the Head Athletic Trainer or designee. All student-athlete s must attend an annual drug educational session. Participation in any athletic activities will be prohibited until the student-athlete has attended/completed this mandatory drug education which includes submitting a signed acknowledgment receipt of the policy and the informed consent form to participate in the testing program. Make-up sessions will be provided for student-athletes that miss their team s scheduled drug educational session. Alcohol policy The Daemen College Alcohol Policy can be found in the Student Handbook ( and is further defined as it relates specifically to student-athletes in the Student-Athlete Code of Conduct. Prohibited acts include: Possessing or consuming alcohol if under the age of 21, Operating a motor vehicle while under the influence of alcohol, Misrepresenting one s age for the purpose of purchasing, possessing, or consuming alcohol, Purchasing, furnishing, or serving alcohol to or for an underage person, Being dangerously intoxicated to the point where State law mandates being taken into custody. Any student-athlete found to be in violation will be disciplined as per the policy by the Office of Student Affairs in addition to the Department of Athletics. If applicable, this may also include loss of privileges and/or additional penalties from the Office of Residence Life. Student-athletes of legal age who chose to consume alcohol will do so in moderation in legally acceptable places, and with an awareness of public perception of drinking as a student-athlete. Student-athletes shall not drink or be in possession of alcohol during any contest, practice, trip or at any other official team or department activity. The Director of Athletics or designee has the authority to impose additional sanctions related to athletic participation based on the severity and/or frequencies of such alcoholrelated offense(s) by student-athletes. Tobacco policy According to the NCAA Division II bylaw , the use of tobacco products is prohibited by all game personnel (e.g., student-athletes, coaches, [athletic] trainers, managers and game officials) in all sports during practice and competition. Furthermore, bylaw states that, the use of tobacco products by a student-athlete is prohibited during practice and competition. A 2 Rev. July 20, 2015

3 student-athlete who uses tobacco products during a practice or competition shall be disqualified for the remainder of that practice or competition. The Director of Athletics or designee has the authority to impose additional sanctions related to athletic participation based on the severity and/or frequencies of any such tobacco-related offense(s) by student-athletes. Illegal Drugs and Controlled Substances policy The Daemen College rules on illegal substances can be found in the Student Handbook ( Prohibited acts include: Possessing or using illegal substances, as defined by law, Possessing or using controlled substances without a properly issued prescription or using a controlled substance in a manner other than as lawfully prescribed, Distributing, selling, or possessing with the intent to distribute illegal or controlled substances, as defined by law, or Engaging in such other acts as prohibited by the Daemen College Athletics Drug and Alcohol Policy. Pursuant to NCAA Division II Bylaw , the use of any illegal and/or banned substance on the current NCAA Banned Drug List (see appendix A) is prohibited by all student-athletes. The Daemen College Institutional Drug Testing Program is a separate and distinct program from the NCAA drug testing program and may test for substances not listed on the NCAA banned drug classes list as well as use detection levels which differ from the NCAA testing program. Common prohibited drugs/banned substances include, but are not limited to: Amphetamines/methamphetamines Cocaine Marijuana Opiates MDMA (Ecstasy) Ephedrine Oxycodone (OxyCotin) Methylphenidate (Ritalin) Synthetic cannabinoids (K2, Spice) Bath salts Anabolic steroids Nutritional and/or Dietary Supplement Policy Department of Athletics personnel will not distribute or endorse the use of any nutritional and/or dietary supplements. The U.S. Food and Drug Administration (FDA) does not strictly regulate the supplement industry, therefore purity and safety of nutritional/dietary supplement ingredients cannot be guaranteed. Impure supplements may contain banned substances which may result in a positive drug test and thus affect the eligibility of student-athletes. Any product containing a dietary supplement ingredient is taken at your own risk. To avoid possible violation of this policy, before consuming any nutritional or dietary supplement, studentathletes should disclose and review the product with the Director of Sports Medicine, Team Physician or designee prior to use (see Appendix B). All supplement questions will be submitted 3 Rev. July 20, 2015

4 via the Drug Free Sport Resource Exchange Center (password is ncaa2). Medical Exceptions All student-athletes are required to disclose to the Sports Medicine staff all medicines (over-thecounter and prescription) as well as any dietary supplements currently being ingested prior to their participation in any intercollegiate activities. It is the student-athlete s responsibility to keep the Sports Medicine staff updated on any new or change in prescription medications. The Department recognizes that certain banned substances may be prescribed by a licensed physician for specific medical conditions. Exceptions may be made for student-athletes who have a documented medical history of necessitating the use of such substances. However, this usage must be in writing and on-file in the student-athletes medical file with the Sports Medicine staff. The student-athlete must provide all medical documentation supporting the medical necessity of the banned substance including, but not limited to: The specific medical condition or diagnosis The name of the medicine A copy of the prescription showing the proper dosage and frequency of medication The length of time the specific medicine and dosage is intended to be utilized. Examples of common conditions and medications that may be subject to a medical exception: Attention Deficit/Hyperactivity Disorder (ADHD) Methylphenidate, Ritalin, Adderall Male pattern baldness Finasteride, Propecia Hypogonadism/Testosterone deficiency testosterone Drug Testing Program All student-athletes with eligibility remaining that are listed on the institutional squad list are subject to drug testing. This includes student-athletes who qualify for medical hardship ( redshirt ) status, have been declared academically ineligible, are injured, are on suspension, and/or are participating in the Safe Harbor/Self-Referral Program (see page 9). As a condition to participate in the Daemen College intercollegiate athletic program, all studentathletes will be required to comply with the Drug Testing Program. Failure to sign the informed consent form (Appendix H) or failure to participate completely in the drug testing program will render the student-athlete ineligible to participate in any intercollegiate athletic program. In addition, any athletic scholarship award will be cancelled. Testing formats The number of testing dates per academic year will be at the sole discretion of the Director of Athletics or designee. Institutional drug testing may occur as announced or unannounced testing in the following formats: 4 Rev. July 20, 2015

5 Random testing Individuals will be selected at random by a computer. The number of student-athletes to be selected will be at the discretion of the Director of Athletics or designee. Reasonable suspicion testing Reasonable suspicion may be brought forward with supporting objective information as determined by and reported to the Director of Athletics by an Associate/Assistant Athletic Director, Director of Sports Medicine, Athletic Trainers, Team Physician, or Head/Assistant Coach (see Appendix C). Selection for reasonable suspicion testing may be based on, but not limited to: o Observed possession or use of substances appearing to be prohibited drugs/banned substances; o An arrest or conviction related to the possession, trafficking or sale of prohibited drugs/banned substances; or o Observable signs including abnormal change in appearance, conduct or behavior reasonably interpreted as being caused by the use of prohibited drugs. Re-entry testing After testing positive for a drug test and after meeting full compliance with any medical treatment as determined by a physician or counselor, suspended studentathletes must submit to a drug test (and receive a negative result) to re-enter full participation status. This re-entry drug test may be at the student-athlete s own expense. Follow-up testing After testing positive for a drug test and returning from suspension, student-athletes will be required to submit to subsequent drug tests at each round of unannounced drug testing. Whole-team testing An entire team would be subject to testing. The number of teams to be tested will be the sole discretion of the Director of Athletics or designee. Pre-Season testing Student-athletes would be subject to pre-season drug testing and may be notified of such by the Director of Athletics or designee at any time prior to their first competition. Post-season/Championship testing Any participant or team likely to advance to postseason championship competition may be subject to additional testing. Testing may be required of all team members or individual student-athletes at any time within thirty (30) day prior to the post-season competition. If a student-athlete tests positive, he or she would be subject to the applicable sanctions. Notification and Reporting for drug testing Once a student-athlete has been selected, they will be notified by the Director of Sports Medicine or designee by phone/text and and scheduled for drug testing within hours. The student-athlete will be given the date, time and location to report for testing as well as instructed to bring photo identification. The student-athlete will be required to confirm the notification to report for testing by reporting to the Athletic Training Facility to complete and sign the Drug Testing Selection Notification form (Appendix D). The Director of Sports Medicine or designee will be present at the drug testing collection site/station to certify the identity of student-athletes reporting for testing. Student-athletes must provide photo identification when entering the drug testing collection site/station. The failure to report for the scheduled drug test will be treated as an automatic positive test result. 5 Rev. July 20, 2015

6 Drug testing procedures The basic test to be utilized for drug testing is a urinalysis. At the Department of Athletics discretion, other types of tests may be used from time to time to determine the presence of prohibited drugs/banned substances. These alternative testing procedures include, but are not limited to, testing samples of blood or hair. The possession and/or use of a prohibited drug/banned substance may be determined by means other than a urinalysis, blood or hair sample. When an individual is found to be in possession and/or observed using a prohibited drug/banned substance, the student-athlete will be subject to the same sanctions that would be followed in the case of a positive urinalysis test. All urine sample collections will be performed and packaged by The National Center for Drug Free Sport. The urine samples will be sent to a reputable third-party certified laboratory that specializes in institutional drug testing procedures. All test administration, urine/specimen collections, specimen labeling, chain of custody handling and laboratory testing procedures will be followed as per Drug Free Sport s guidelines and procedures (see Appendix E). These guidelines and procedures will be reviewed at the time of the preseason or start of the semester meeting. Disclosure of Drug Testing Results All test results will be reported to the Director of Athletics and Director of Sports Medicine. If the laboratory reports any suspicious specimens (e.g., adulterated or substituted), the studentathlete(s) in question will be deemed to have refused to submit to the drug test and will be subjected to sanctions for a positive drug test. In the event of a positive drug test result, the Director of Athletics or designee will notify the student-athlete and Head Coach of the positive drug test. After student-athlete notification, the Director of Athletics or designee will schedule a meeting with the student-athlete, Head Coach and Director of Sports Medicine or designee to discuss the positive drug test result and the applicable sanctions. All points of the specific sanction will be explained in detail and the student-athlete will sign a Positive Drug Test Notification form acknowledging that they have been made duly informed of all pending sanctions and their right to appeal (see Appendix F). The Director of Athletics or designee may also disclose the positive drug test result to other College officials when he/she determines, at their sole discretion, that the relevant official has a legitimate need to know interest. Positive Test Result Sanctions The following penalties will apply to any student-athlete that: Tests positive for any prohibited drug/banned substance. Refuses to submit to a required drug test, fails to report for a scheduled drug test and/or provides a suspicious specimen. Cannot provide a urine sample in a reasonable amount of time (as determined by the assigned Drug Free Sport specimen collector). 6 Rev. July 20, 2015

7 Leaves the testing location before providing an adequate urine sample. Tests positive from a drug test provided by the NCAA, ECC or any other outside agency. Sanctions under this policy will be in addition to any imposed by the specific governing body or other agency. First Positive test Suspension from 10% of the contests/play dates of the student-athlete s championship season (excluding scrimmages, exhibition and non-championship segment games). o Based on percentage, if the number of suspended contests/play dates is any fraction, it will be rounded up to the next whole number (e.g., 2.4 will be rounded up to 3). o The suspension will be consecutive games/play dates effective with the next scheduled regular season or playoff game. o If the suspension is not completed during one season of play, it will carry over to the next championship season. o If the positive test result occurs outside the championship season, the suspension will begin at the first regularly scheduled game/play date of the next championship season. The student-athlete will be required to notify his/her parents or legal guardians, via telephone in the presence of the Director or Athletics or designee. The student-athlete will be required to contact the College Counseling Services office for a drug counseling evaluation. The counselor will determine the need for any further intervention and/or treatment. The student-athlete must comply with the counselor s treatment plan. o Failure to comply with the counselor s plan of care may be treated as a second positive test at the discretion of the Director of Athletics or designee. The student-athlete will not be permitted to return to competition until he/she has had a negative re-entry drug test. However, this re-entry drug test will only occur after evidence has been provided by the counselor that states the student-athlete has fully complied with the plan of care. This re-entry drug test may be at the student-athlete s own expense. The student-athlete will be required to submit a urine sample for follow-up drug testing at each subsequent round of unannounced institutional drug testing dates. o Redemption clause if the student-athlete has 2 consecutive negative follow-up drug test results, the student-athlete will have earned redemption. This will release the student-athlete from the requirement of submitting a urine specimen for follow-up testing at each subsequent unannounced institutional drug testing date. Second Positive test Suspension from 50% of the contests/play dates of the student-athlete s championship season (excluding scrimmages, exhibition and non-championship segment games). o Based on percentage, if the number of suspended contests/play dates is any fraction, it will be rounded up to the next whole number (e.g., 4.3 will be rounded up to 5). 7 Rev. July 20, 2015

8 o The suspension will be consecutive games/play dates effective with the next scheduled regular season or playoff game. o If the suspension is not completed during one season of play, it will carry over to the next championship season. o If the positive test result occurs outside the championship season, the suspension will begin at the first regularly scheduled game/play date of the next championship season. The student-athlete will be required to notify his/her parents or legal guardians, via telephone in the presence of the Director or Athletics or designee. The student-athlete will be required to attend mandatory counseling at the College Counseling Services office or with a physician/counseling agency or a certified drug rehabilitation program that is agreeable to the Director of Athletics or designee. The physician, counselor and/or drug rehab program will determine the extent of medical intervention and/or treatment. The student-athlete must comply with the physician s, counselor s and/or drug rehabilitation treatment plan. o Failure to comply with the drug rehabilitation program s plan of care may be treated as a third positive test at the discretion of the Director of Athletics or designee. The student-athlete will not be permitted to return to competition until he/she has had a negative re-entry drug test. However, this re-entry drug test will only occur after evidence has been provided by the treating physician, counselor and/or certified drug rehabilitation program that states the student-athlete has fully complied with the plan of care. This reentry drug test may be at the student-athlete s own expense. The student-athlete will be required to submit to future follow-up drug testing at each successive round of unannounced institutional drug testing dates for the remainder of their eligible athletic career. Third Positive test The student-athlete will be dismissed from the Daemen College intercollegiate athletic program. Permanent cancellation of athletic eligibility and any athletic scholarship award. Parents and/or legal guardians will be notified by the Director of Athletics or designee of the cancellation of eligibility and any athletic financial aid. The student will be encouraged and directed to seek counseling and/or substance abuse intervention services provided by the College. However these services will not be initiated, monitored or provided by the Department of Athletics as the student will have been discharged from athletic participation. Appeal Process Student-Athletes who test positive for a banned substance by the laboratory retained by the College may, within seventy-two (72) hours following receipt of notice of the laboratory finding, contest the finding. Upon the student-athlete s request for additional testing of the sample, the Director of Athletics or his/her designee will formally request the laboratory to perform testing on 8 Rev. July 20, 2015

9 specimen B. Specimen B findings will be final, subject to the results of any appeal. If specimen B results are negative, the drug test will be considered negative. Student-athletes who test positive under the terms of this policy will be entitled to a hearing with the Director of Athletics or his/her designee prior to the imposition of any sanction. Requests for such a hearing must be made within forty-eight (48) hours of notification of a positive test result. If the forty-eight (48) hours would end on a weekend or holiday, the request must be made by 12- noon on the next business day. Requests must be in writing and received by the Director of Athletics or his/her designee. The student-athlete may have an advocate or other representative present if the student so desires. However, the student-athlete must present his or her own case. The meeting would take place no more than seventy-two (72) hours after the written request is received. Either the student-athlete or the other parties involved may request an extension of time to the Director of Athletics, who will consider whether to grant the extension upon a showing of good cause. 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 confidential. The decision by the Director of Athletics or his/her designee regarding the sanction to be imposed shall be final. Safe Harbor and Self-Referral Voluntary disclosure of prohibited drug/banned substance use may occur at any time by making a self-referral for counseling*. If a student-athlete feels they need to speak to a physician and/or a counselor about substance abuse, they should contact the Director of Sports Medicine or their designee for assistance and as a means of documenting the voluntary disclosure on the Safe Harbor Acknowledgement Form (see Appendix G). If a student-athlete self-refers, they will still be subjected to a drug test to establish a baseline for the follow-up drug testing. Safe Harbor status will be granted (if applicable*) if the student-athlete s self-referral occurred before being selected for an unannounced drug test, the test result will not be considered positive for sanctions described in this policy. If however, the self-referral occurs after being selected for an unannounced drug test, any resulting positive test will incur the full sanctions of this policy. Any self-referral within 30-days prior to NCAA or ECC post-season competition may render a student-athlete ineligible to compete in those contests at the discretion of the Director of Athletics or designee. Any self referral will require a physician and/or counselor to evaluate the student-athlete and create a plan of care in which the student-athlete must follow if they choose to continue to participate in Daemen College intercollegiate athletics. By virtue of this voluntary disclosure, the Safe Harbor designation allows student-athletes to continue to participate in full provided the physician and/or counselor agrees this is in the best interest of the student-athlete. 9 Rev. July 20, 2015

10 The student-athlete must demonstrate compliance with the established treatment plan. o Any failure to comply with the treatment plan will require the student-athlete to be sanctioned as if he/she received the next subsequent positive drug test. The student-athlete will be given 30 days to complete the treatment plan, unless the physician and/or counselor suggest an extension is necessary. The student-athlete will undergo a follow-up drug test at the completion of the treatment plan. o If the drug test is negative, the student-athlete will be considered rehabilitated and may return to participation without further suspicion. o If the drug test is positive, the student-athlete will be sanctioned as if he/she received the next subsequent positive drug test. The student-athlete will be subject to additional follow-up drug testing for one calendar year. *Student-athletes may self-refer at any time, however, they will not qualify for Safe Harbor status if they have already tested positive within any drug-testing program. 10 Rev. July 20, 2015

11 Appendix A 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: 1. Stimulants; 2. Anabolic Agents; 3. Alcohol and Beta Blockers (banned for rifle only); 4. Diuretics and Other Masking Agents; 5. Street Drugs; 6. Peptide Hormones and Analogues; 7. Anti-estrogens; and 8. 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: 1. Blood Doping; 2. Gene doping; 3. Local Anesthetics (under some conditions); 4. Manipulation of urine samples; 5. Beta-2 Agonists permitted only by prescription and inhalation. NCAA Nutritional/Dietary Supplements Warning: Before consuming any nutritional/dietary supplement product, review the product with the appropriate or designated athletics department staff. There are no NCAA approved supplement products. 1. Dietary supplements, including vitamins and minerals, are not well regulated and may cause a positive drug test result. 2. Student-athletes have tested positive and lost their eligibility using dietary supplements. 3. Many dietary supplements are contaminated with banned drugs not listed on the label. 4. Any product containing a dietary supplement ingredient is taken at your own risk. Check with your athletics department staff prior to using a supplement. Page 1 of 2 11 Rev. July 20, 2015

12 Examples of NCAA Banned Substances in Each Drug Class Note to Student-Athletes: There is no complete list of banned substances. Do not rely on this list to rule out any supplement ingredient. 1. Stimulants: Amphetamine (Adderall); caffeine (guarana); cocaine; ephedrine; fenfluramine (Fen); methamphetamine; methylphenidate (Ritalin); phentermine (Phen); synephrine (bitter orange); methylhexaneamine, bath salts (mephedrone); octopamne; DMBA; etc. Exceptions: phenylephrine and pseudoephedrine are not banned. 2. Anabolic Agents (sometimes listed as a chemical formula, such as 3,6,17- androstenetrione): Androstenedione, boldenone; clenbuterol; DHEA (7-Keto); eiptrenbolone; etiocholanolone; methasterone; methandienone; nandrolone, norandrostenedione; ostarine; stanozolol; stenbolone; testosterone; trenbolone; SARMS (ostarine); etc. 3. Alcohol and Beta Blockers (banned for rifle only): Alcohol; atenolol; metoprolol; nadolol; pindolol; propranolol; timolol; etc. 4. Diuretics (water pills) and Other Masking Agents: Bumetanide; chlorothiazide; furosemide; hydrochlorothiazide; probenecid; spironolactone (canrenone); triameterene; trichlormethiazide; etc. 5. Street Drugs: Heroin; marijuana; tetrahydrocannabinol (THC); synthetic cannabinoids (eg. spice, K2, JWH-018, JWH-073). 6. Peptide Hormones and Analogues: Growth hormone (hgh); human chorionic gonadotropin (hcg); erythropoietin (EPO); IGF-1; etc. 7. Anti-Estrogens: Anastrozole; tamoxifen; formestane; ATD; clomiphene; SERMS (nolvadex); etc. 8. Beta-2 Agonists: Bambuterol; formoterol; salbutamol; salmeterol; higenamine; norcoclaurine; etc. Additional examples of banned drugs can be found at 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, or password ncaa1, ncaa2 or ncaa3. It is your responsibility to check with the appropriate or designated athletics staff before using any substance. Page 2 of 2 12 Rev. July 20, 2015

13 Appendix B Department of Athletics Student-Athlete Dietary Supplement Disclosure & Review Form I,, am taking or intend to take the following nutritional and (Student-Athlete s Name) or dietary supplements. I acknowledge the risk of losing my eligibility to participate in intercollegiate athletics if I test positive for a Daemen College or an NCAA banned substance that may be found in any substance that I take, regardless of the reason or purpose for taking such supplements. I acknowledge and understand that the labeling on these products can be misleading and inaccurate, and that sales personnel are neither motivated nor qualified to accurately certify that these products contain no banned substances. Healthy or naturally occurring are terms often used to market sales of dietary supplements, but do not necessarily mean they are safe. Before taking or using any nutritional and/or dietary supplement, I am responsible for ensuring the product does not contain any banned substance. By making this disclosure, I am requesting that these products and their ingredients by reviewed by Daemen College s Sports Medicine staff for the purposes of determining whether they are medically safe to use and do not contain banned substances. I understand that I should not take or use these products until their usage has been reviewed by the Daemen College s Sports Medicine staff. Product & Manufacturer s Name: Listed Ingredients: (Athletic Trainer to review, circle banned substances and notify student-athlete) 13 Rev. July 20, 2015

14 Appendix C Department of Athletics Drug Testing Reasonable Suspicion Reporting Form I,, under the reasonable suspicion clause that is outlined in (Athletic Dept Staff Name) The Institutional Drug Education and Drug Testing Policy, report the following objective sign(s), symptom(s) or behavior(s) that I reasonably believe warrant be referred to the Director of Athletics or his/her (Student-Athlete s Name) designee 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: Irritability Loss of temper Poor motivation Failure to follow directions Verbal outburst (e.g. to faculty, staff, teammates) Physical outburst (e.g. throwing equipment) Emotional outburst (e.g. crying) Weight gain Weight loss Sloppy hygiene and/or appearance The Student-Athlete has been: Late for practice Late for class Not attending class Receiving poor grades Staying up too late Missing appointments Missing/skipping meals The Student-Athlete has demonstrated the following: Dilated pupils Constricted pupils Red eyes Smell of alcohol on the breath Smell of marijuana Staggering or difficulty walking Constantly running and red nose Recurrent bouts with a cold or flu (provide dates: ) Over-stimulated or hyper Excessive talking Withdrawn and/or less communicative Periods of memory loss Slurred speech Recurrent motor vehicle accidents and/or violations (provide dates: ) Recurrent violations of the Student Code of Conduct policy Page 1 of 2 14 Rev. July 20, 2015

15 Other specific objective findings include: Signatures: Name of Athletic Department Staff Signature of Athletic Department Staff Date Reviewed By: Director of Athletics/Designee Date Name of Counselor Consulted Date Consulted Reasonable Suspicion Upheld Reasonable Suspicion Denied Page 2 of 2 15 Rev. July 20, 2015

16 Appendix D Department of Athletics Student-Athlete Drug Testing Selection Notification Form Student-Athlete: Student ID: Date of Notification: Sport: Time of Notification: a.m./p.m. I,, the undersigned: Student-Athlete Acknowledge being notified to appear for institutional drug testing and have been notified to report to the drug testing station at:, on at or before a.m./p.m. I will be prepared to provide an adequate urine specimen and will not over hydrate. I understand that providing numerous diluted specimens may be cause for follow-up drug testing. I understand that I may have a witness accompany me into the urine collection station and be observed providing my urine specimen. I understand that failure to appear at the site on or before the designated time will constitute a withdrawal of my previous consent to be tested as part the Institutional Drug Testing Informed Consent and will result in a penalty. By signing below, I acknowledge being notified of my participation in institutional drug testing, and I am aware of what is required of me in preparation of this drug testing event. Signature: Student-Athlete Date: I can be reached at the following telephone number on test day: (Cut here) Institutional Representative retain top portion of completed form Daemen College Drug Testing Program Student-Athlete: Location of Test: Date of Test: Report Time: **Report To The Test Site with Picture Identification** DO NOT OVERHYDRATE OR DRINK TOO MANY FLUIDS 16 Rev. July 20, 2015

17 Appendix E College/University Urine Collection Guidelines for Clients 1. Only those persons authorized by the institution will be allowed in the collection room. 2. When arriving to the collection room, the student-athlete will provide photo identification or a client representative will need to identify the student-athlete. The student-athlete will then print his or her name and arrival time on the Roster Sign-In Form. 3. The student-athlete will select a Custody & Control Form (CCF) from a supply of such and work with the institutional collector to complete the necessary information before proceeding with the specimen collection process. 4. The student-athlete will select a specimen collection beaker from a supply of such and will be escorted by the institutional collector (same gender) to the restroom to provide a specimen. The student-athlete will rinse his or her hands with water (no soap) and then dry their hands. Then the student-athlete will place a specimen barcode from the Custody & Control Form onto the beaker. 5. The institutional collector will directly observe the furnishing of the urine specimen to assure the integrity of the specimen. 6. The student-athlete will be responsible for keeping the collection beaker closed and controlled. 7. Fluids and food given to student-athletes who have difficulty voiding must be from sealed containers (approved by the institutional collector), opened and consumed in the collection room. These items must be free of any other banned substances. 8. If the specimen is incomplete, the student-athlete must remain in the collection room until the sample is completed. During this period, the student-athlete is responsible for keeping the collection beaker closed and controlled. 9. If the specimen is incomplete and the student-athlete must leave the collection room for a reason approved by the institutional collector, the specimen must be discarded. 10. Upon return to the collection room, the student-athlete will begin the collection procedure again. 11. Once an adequate volume specimen is provided; the institutional collector will escort the student- athlete to the specimen processing table. 12. The specimen processor will instruct the student-athlete to closely observe the specimen processing steps and will then measure the specific gravity. 13. If the urine has a specific gravity below 1.005, no value will be recorded on the CCF and the specimen will be discarded by the student-athlete with the institutional collector observing. The student-athlete must remain in the collection room until another specimen is provided. The student- athlete will provide another specimen. 7/29/2013 Confidential and proprietary information of The National Center for Drug Free Sport, Inc. Page 1 of 2 17 Rev. July 20, 2015

18 College/University Urine Collection Guidelines for Clients 14. Once the specimen processor has determined the specimen has a specific gravity above the sample will be processed and sent to the laboratory. 15. If the laboratory determines that a student-athlete s sample is inadequate for analysis, at the client s discretion, another sample may be collected. 16. If a student-athlete is suspected of manipulating specimens (e.g., via dilution, substitution), the institutional collector will collect another specimen from the studentathlete. 17. Once a specimen has been provided that meets the on-site specific gravity, the studentathlete will select a sample collection kit from a supply of such. 18. The specimen processor will open the kit, demonstrate to the student-athlete the vials are securely sealed, open the plastic and open the A vial lid. The processor will pour the urine into the A and B vials and close the lids. The specimen processor should pour urine into vials above the minimum volume level (35 ml in A vial; 15 ml in B vial) and pour as much urine as possible into the vials using care not to exceed the maximum levels (90 ml in A vial; 60 ml in B vial). 19. The specimen processor will securely close the lids on each vial and then seal each vial using the vial seals attached to the CCF; assuring seals are tightly adhered to the vials with no tears or loose areas. 20. The specimen processor must then collect all necessary signatures (collector, donor, witness, and collector/specimen processor) and dates/times where indicated on the CCF. 21. The specimen processor will place the laboratory copy of the CCF in the back pouch of the plastic bag and the vials in the front pouch of the same bag. The bag should then be sealed. The sealed bag with vials will then be placed in the sample box. The box will then be sealed. 22. The student-athlete is then released by the institutional collector. 23. All sealed samples will be secured in a shipping case. The collector will prepare the case for forwarding. When two split samples are collected and packaged, care must be taken to assure one sample is placed in the shipping container for shipment to the drugs of abuse laboratory and one sample is placed in the shipping container for shipment to the anabolic steroids laboratory. 24. After the collection has been completed, the samples will be forwarded to the appropriate laboratory and copies of any forms forwarded to the Sport Drug Testing Department. 25. The samples then become the property of the client. 26. If the student-athlete does not comply with the collection process, the institutional collector will notify the appropriate institutional administrator and Drug Free Sport. 7/29/2013 Confidential and proprietary information of The National Center for Drug Free Sport, Inc. Page 2 of 2 18 Rev. July 20, 2015

19 Appendix F Department of Athletics Student-Athlete Positive Drug Test Notification Form Student-Athlete: Sport(s): Date of Notification: Student ID: Date of Drug Test: Time of Notification: a.m./p.m. I,, the undersigned, acknowledge that I have been duly Student-Athlete notified of testing positive for the following banned substance(s) as a result of the Institutional Drug Testing Program: Amphetamines/methamphetamines Cocaine Marijuana Opiates: MDMA (Ecstasy) Ephedrine Oxycodone (OxyCotin) Methylphenidate: Synthetic substances: Performance enhancing drugs:_ Other: I have been informed that as a consequence of my positive result, I am subject to the following sanction level and the penalties as outlined therein: First Positive Second Positive Third Positive Date of 1 st positive: Date of 1 st positive: Date of 2 nd positive: I also have been informed of my right to appeal this positive test result in writing within 72 hours as outlined in the institutional Drug Testing Program Policy. By signing below, I understand that failure to comply with any of the penalties may result in loss of eligibility, athletic funding (scholarship) and/or dismissal from the intercollegiate athletics program. Signature: Student-Athlete Date: Signature: Director of Athletics or designee Date: 19 Rev. July 20, 2015

20 Appendix G Department of Athletics Safe Harbor Program Acknowledgement Form I,, understand that, according to the Department of Athletics (Student-Athlete s Name) Institutional Drug Education and Testing Program Policy, I may self-refer into the Safe Harbor Program once during my intercollegiate athletic career for voluntary evaluation and counseling. I further understand that I am not eligible for the Safe Harbor Program in the following situations: After being notified that I have been selected for impending drug test. After having received notification of a positive institutional or NCAA drug test. Thirty (30) days prior to Conference or NCAA post-season competition. Daemen College will work with me to provide a treatment plan which may include confidential banned substance testing. I will be furnished with a copy of the treatment plan and guidelines after an initial meeting with a substance abuse counselor to evaluate the extent of my substance use. I understand that if I test positive for a banned substance upon entering the Safe Harbor Program, the initial test result will not result in any administrative sanction, but may be suspended from play or practice if medically warranted. I will be permitted to remain in the Safe Harbor Program for a reasonable period, not to exceed thirty (30) days, as determined by the treatment plan. If I fail to comply with the treatment plan, I will be removed from the Safe Harbor Program and my initial Safe Harbor positive test will be treated as a first positive and subject to the sanctions as set forth in the policy. While in the Safe Harbor Program, I will not be included in the regular random testing program, but may be selected for drug testing by the NCAA. Upon successful completion of the Safe Harbor Program, I will be subject to additional testing for one calendar year. The Director of Athletics, the Team Physician, the Director of Sports Medicine and my Head Coach or his/her designee will be informed of my participation in the Safe Harbor Program. My assistant coach(es) may be notified at the discretion of the Head Coach or designee. Other College employees may be informed only to the extent necessary for the implementation of this policy. Signature: Student-Athlete Date: Signature: Director of Athletics or designee Date: 20 Rev. July 20, 2015

21 Appendix H Department of Athletics Student-Athlete Institutional Drug Testing Informed Consent Form I,, was in attendance at the preseason meeting, start of the semester presentation or was individually instructed on the Department of Athletics Drug Testing Program and have received a copy of the Institutional Drug Education and Testing Program Policy ( Policy ). By signing this form, I am consenting to have, in accordance with the criteria outlined in the Policy, periodic urine specimens collected by qualified personnel as selected by the Daemen College Department of Athletics and sent to an independent laboratory for testing for prohibited drugs/banned substances. I also understand that my consent to participate includes my intent to willfully adhere to all and any sanctions, counseling, rehabilitation, follow-up and/or re-testing requirements as defined in the Policy. I have been informed that nutritional/dietary supplements are not well regulated and may cause a positive drug test result. Furthermore, I have been warned that any product containing a nutritional/dietary supplement ingredient is taken at my own risk. I understand that as long as I m participating as a Daemen College Student-Athlete, unannounced drug testing may occur at any time and that I have the responsibility before consuming any nutritional/dietary supplement to have the product reviewed by the Director of Sports Medicine or designee. I authorize the release of my testing results to the Director of Sports Medicine, Team Physician, Director of Athletics, my Head Coach(es) and my parents (if under 18 yrs old). As outlined in the Policy, other College Administrators may be informed on an as needed basis, if the Director of Athletics deems it necessary. I release Daemen College, its officials, employees and representatives from any and all liability and waive the right to bring any claim against the College for the release of any information and/or any result arising from my participation in the Institutional Drug Education and Testing Program. I understand that I may choose not to sign this form. If I do not sign this form, I fully understand that I will not be able to participate in the intercollegiate athletic program(s) at Daemen College and that I will forfeit any athletic scholarship award. I attest that I have read and completely understand the Policy and hereby voluntarily consent to participate and agree to abide by all facets of the Daemen College Institutional Drug Testing Program Policy. Print: Sign: Date: Student-Athlete Student-Athlete If Student-Athlete is under 18 yrs: Print: Sign: Date: Parent/Guardian Parent/Guardian 21 Rev. July 20, 2015