1 OKLAHOMA CHRISTIAN SCHOOLS EMPLOYEE POLICY FOR A DRUG AND ALCOHOL FREE CAMPUS JANUARY 2010
2 OCS EMPLOYEE POLICY FOR A DRUG AND ALCOHOL FREE CAMPUS I. POLICY A. OCS POLICY - Oklahoma Christian Schools ( OCS ) maintains a drug and alcohol free campus. As an employee of OCS, you have confirmed your commitment to the Christian walk and you have agreed to abide by the mission, policies and practices of OCS. As a result, each OCS employee is in a position of Christian leadership as a role model to the students, among their peers and in our community. Therefore, each OCS employee has a heightened responsibility to not only refrain from drug and alcohol abuse but to be above reproach in this regard, and to discourage chemical abuse by others, not only while at school and school related events, but also in his or her personal and social life outside of school. The following provisions concerning the abuse of drugs and alcohol (the Policy ) have been adopted by OCS. This Policy applies to all employees of OCS, as well as any temporary and/or contract employees and applicants for employment. All employees and applicants shall be subject to this Policy, including those employees or applicants assigned to jobs covered by federal laws or regulations regarding drug testing (including those issued by the Department of Transportation and Defense), as long as the drug testing at issue was not authorized and/or being given pursuant to any federal rule or regulation. Violations of any provision of this Policy may result in disciplinary action, up to and including discharge. This Policy becomes effective June 1, If any OCS employee has reason to suspect that another OCS employee may be abusing drugs or alcohol, that employee shall report the matter, as soon as possible, to the appropriate principal or the Headmaster, whichever is most appropriate under the circumstances. The principal or designee shall immediately notify the Headmaster of the matter. Drug test results, positive or negative, are not required in order to establish a violation of this policy on chemical abuse. Any violation of this policy, proven to the satisfaction of OCS Administration, will subject the violating employee to the disciplinary actions set forth herein. This Policy is for guidance only and does not create a contract of employment and is subject to change, modification, or elimination at anytime and without notice.
3 B. Policy Compliance - Compliance with OCS s Drug and Alcohol Abuse Policy and Testing Program is a condition of continuing employment. Employees and applicants will be asked to acknowledge, by means of signing a statement, that they have read and understand OCS s Policy and that they agree to be tested if asked to do so by OCS. Employees who refuse to sign the acknowledgment form may be subject to disciplinary action, up to and including discharge. Applicants who refuse to sign the acknowledgement form will not be hired. If the employee or applicant is required to undergo drug or alcohol testing, he or she will also be required to sign a consent form consenting to the test. Refusal to sign the consent form will normally subject the employee to disciplinary action, up to and including discharge. Applicants who refuse to sign the consent form and/or undergo testing will not be hired. C. Reservation Of Rights - OCS reserves the right to change the provisions of this Policy and its accompanying procedural guidelines at any time, in accordance with the law. II. DEFINITIONS For purposes of this Policy, unless defined elsewhere in this Policy or unless the context requires otherwise, terms and expressions used herein have the following meanings and definitions: Alcohol means any substance as defined in Title 37, Oklahoma Statutes, Sections or 506. Applicant means a person who has applied for a position with OCS. Confirmation Test - means a drug or alcohol test on a sample to substantiate the results of a prior drug or alcohol test on the same sample and which uses different chemical principles and is of equal or greater accuracy than the prior drug or alcohol test. Drugs or "illegal drugs means amphetamines, cannabinoids, cocaine, phencyclidine (PCP), hallucinogens, methaqualone, opiates, barbiturates, benzodiazepines, synthetic narcotics, designer drugs, or a metabolite of any of the substances listed herein. "Illegal drugs" includes, but is not limited to, all scheduled drugs as defined by law, all prescription drugs obtained without authorization, and all prescribed and over-the-counter drugs being used for an abusive purpose or, otherwise as defined in Title 63 Oklahoma Statutes, Section The use of the term Drugs or Illegal drugs shall also include performance enhancing drugs. Drug Paraphernalia means equipment/apparatus designed for or used for the
4 purpose of measuring, packaging, distributing or facilitating the use of drugs. "Drug use test" means a chemical test administered for the purpose of determining the presence or absence of a drug or its metabolites or alcohol in a person s bodily tissue, fluids, or products. "EAP" means an in-house or contracted program which at a minimum provides drug and alcohol dependency evaluation and referral services for substance abuse counseling, treatment, or rehabilitation. "Employee" for purposes of this Policy, includes any person, other than a vendor, who repetitively supplies a service for remuneration to OCS, including temporary and/or contract employees. "Impairment" means, without limitation, the diminution of a person s sight, hearing, balance, reaction, reflex, or judgment to such a degree that the person s ability to perform required duties or activities is limited. "Medical Review Officer (MRO) means a physician, qualified by the State Board of Health, with specialized training and certification in the evaluation of drug test results. The MRO is tasked with the review of all confirmed positive laboratory test results, and verification of any prescription medications the employee may be taking. The MRO will make a final determination of the result status based on this review prior to test results being reported to the designated contact at OCS. "Positive" when referring to a drug use test administered under this policy means a toxicological test result which is considered to demonstrate the presence of an illegal or a performance enhancing drug or the metabolites thereof using the standards customarily established by the testing laboratory administering the drug use test. Possession means having the item in issue (e.g. drugs) on one's person or knowing of the presence of the substance and having physical control of it (actual possession), or having the power and intention to control the substance (constructive possession) such as by the owner of a motor vehicle, locker, package or case, or by the driver of a motor vehicle or the one in possession of the package or case, if the owner is not present, who is keeping or allowing to be kept in the vehicle, package or case the item in issue (e.g. drugs). Prescribed drugs are drugs being used by an employee under a current, valid doctor s prescription and used in the manner prescribed. "Prohibited Activity" as used herein includes, without limitation, those actions and activities described in Section IV of this Policy. "Random selection method" means a basis for selecting employees for drug
5 testing that: Results in an equal probability that any employee from a group of employees subject to the selection mechanism will be selected and does not give the school discretion to waive the selection of any employee selected under the mechanism. "Reasonable suspicion" means a belief that an employee is using or has used drugs or alcohol in violation of this Policy drawn from specific objective and articulable facts and reasonable inferences drawn from those facts in light of experience, and may be based upon, among other things: (1) observable phenomena, such as the physical symptoms or manifestations of being under the influence of a drug or alcohol while at work or on duty, or the direct observation of drug or alcohol use while at work or on duty; (2) a report of drug or alcohol use while at work or on duty, provided by reliable and credible sources and which has been independently corroborated; (3) evidence that an individual has tampered with a drug or alcohol test during his employment with OCS; or (4) evidence that an employee is involved in the use, possession, sale, solicitation, or transfer of drugs while on duty or while on OCS s premises or operating OCS s vehicles, machinery, or equipment "Sample" means tissue, fluid, or product of the human body chemically capable of revealing the presence of drugs or alcohol in the human body. "Standards of Workplace Drug and Alcohol Testing Act" means Okla. Stat. tit. 40, 551 et. seq. and the implementing regulations. Substance abuse means the possession of or use by an OCS employee of drugs or alcohol or both. III. SEARCHES AND INSPECTION For the purpose of assuring compliance with this and other OCS policies, employees may be asked to submit to a search of any vehicle brought onto OCS premises or worksites, including customer worksites; to submit to a search of any packet, package, purse, briefcase, tool box, lunch box, or other container brought onto OCS premises or worksites, including customer worksites; or to submit to a search of desk, file, locker, or other stationary container provided by OCS, whether or not such container, briefcase, backpack, etc., is locked. Refusal to consent to a search or inspection may result in disciplinary action, up to and including discharge. OCS Administration may also, at its discretion, invite law enforcement or other qualified personnel to conduct random searches or assist in a specific search on OCS property. Such a search may include any and all personal property of OCS employees.
6 If an OCS principal or the Headmaster has received what he or she believes to be proof of substance abuse, including but not limited to an employee who tests positive for drug use or an employee is found to be in possession of drugs or drug paraphernalia or is under the influence of drugs, the employee will be disciplined according to OCS policy, up to and including suspension or dismissal, at the discretion of the appropriate principal and the Headmaster. Any drug prescribed by a physician for use by an employee must be in a container which includes the prescription. Possession of a drug without a prescription shall be sufficient evidence of chemical abuse requiring further investigation. Possession by an employee of a prescribed drug in a manner which complies with this policy may be verified by the principal, the Headmaster or their designee. IV. PROHIBITED ACTIVITIES A. Impairment Prohibited - Being under the influence of any controlled substance, alcohol, or illegal drugs, that impair the employee s sight, hearing, balance, reaction, reflex, or judgment while on OCS premises or while performing OCS business is prohibited and may result in disciplinary action, up to and including discharge. B. Possession Prohibited - The use, sale, possession, transfer, or purchase of drugs, drug paraphernalia or alcohol on OCS premises or while performing any OCS business is prohibited and will normally result in disciplinary action, up to and including discharge. However, the proper and appropriate use of prescribed drugs by the person for whom they were prescribed (or by the parent or guardian of such person) and in the method prescribed are not prohibited. C. Prescription Drugs - Bringing a prescribed drug onto OCS premises by any person other than the one for whom it is prescribed (or by the parent or guardian of such person) is prohibited and may result in disciplinary action, up to and including discharge. Prescription drugs may be used only in the manner, combination, and quantity prescribed. D. Positive Test - Testing positive for a drug or alcohol as provided in this Policy is prohibited and will normally result in disciplinary action, up to and including discharge. E. Refusal To Submit To Testing - Refusing to submit to drug or alcohol testing is prohibited and will normally result in disciplinary action, up to and including discharge.
7 F. Refusal To Consent To Testing - Refusing to execute any consent, release, or other document in connection with this Policy is prohibited and will normally result in disciplinary action, up to and including discharge. G. Refusal To Consent To Search - Refusing to cooperate in or, where required, consent to a search or inspection conducted pursuant to the provisions of this or other OCS policies is prohibited and will normally result in disciplinary action, up to and including discharge. H. Tampering - In the event that it is determined that a sample has been diluted or otherwise tampered with, the subject employee may be, depending upon the circumstances, subject to disciplinary action, up to and including discharge. I. Criminal Conviction - Employees convicted of violating any criminal drug statute must inform the appropriate principal or the Headmaster of such conviction within five (5) days of the conviction date. V. PROCEDURES FOR EMPLOYEE SUBSTANCE ABUSE TESTING Each OCS applicant, employee shall be provided with a copy of the "Employee Drug Policy and Testing Consent" form which shall be read, signed, and dated by the employee. The form is the consent of the employee that the employee will provide a urine and/or hair sample for purposes of testing in accordance with this policy. No applicant or employee shall be accepted for employment at OCS unless they have returned the properly signed "Employee Drug Policy and Testing Consent" form. Applicants and employees may be required to submit to testing under the following circumstances: (a) Upon a conditional offer of employment, applicants may be required to undergo testing. (b) When the employee is selected by the random selection method to provide a urine sample. As often as OCS Administration deems appropriate, employees will be chosen for drug use testing on a random selection basis from a list of all employees. OCS Administration will determine the number of employees names to be drawn at random to submit to a drug test. (c) At any time when there is reasonable suspicion to test the employee for substance abuse; (d) When the employee or another person has sustained a work-related injury or the employer s property has been damages, including damage to
8 equipment, in the amount reasonably estimated at the time of the accident to exceed Five Hundred Dollars ($500.00); (e) When the testing is conducted as a routine part of a routinely scheduled employee fitness-for-duty medical examination or is scheduled for all members of an employment classification; (f) OCS may require an employee to undergo drug and/or alcohol testing, without prior notice, for a period of up to two (2) years commencing with the employee s return to work, following a confirmed positive test or following participation in a drug or alcohol dependency treatment program under an employee benefit program or at the request of OCS. VI. SUBSTANCES A. The OCS drug testing program is designed to determine the presence of the following illegal substances: Amphetamines, cannabinoids, cocaine, phencyclidine (PCP), hallucinogens, methaqualone, opiates, barbiturates, benzodiazepines, synthetic narcotics, designer drugs, performance enhancing drugs or a metabolite of any of the substances listed herein. The common names for these drugs include, but are not limited to, Desoxyn, Dexedrine, marijuana, Morphine sulphate, Codeine, Dilaudid, Percodan, Seconal, Nembutal, Amytal, Fiorinal, Luminal, Phenobarbital, Librium, Valium, Serax, Ativan, Dalmane, Tranxene, Methadone, Dolophine, Propoxyphene, and Darvon B. Substances tested shall be for drugs and alcohol as defined by the Standards of Workplace Drug and Alcohol Testing Act, including controlled substances approved for testing by rule by the State Commissioner of Health. VII. TESTING METHODS A. Alcohol Tests: Alcohol screening is the initial test to determine the presence or absence of alcohol and may be performed on breath or saliva or as otherwise provided for by the Standards of Workplace Drug and Alcohol Testing Act and its implementing regulations. An alcohol concentration of 0.02 or greater shall be considered a positive initial test for alcohol and shall be confirmed as required by the Standards of Workplace Drug and Alcohol Testing Act and its implementing regulations. All positive initial alcohol screening
9 tests shall be confirmed using breath analyzed by an evidential breath testing ( EBT ) device or, in certain specified circumstances, blood analyzed by gas chromatography ( GC ). An alcohol concentration of 0.02 or greater shall be considered a positive confirmation test for alcohol. B. Drug Tests 1. Testing - Drug Screening is the initial test performed on urine, saliva or hair specimens or as otherwise provided for by the Standards of Workplace Drug and Alcohol Testing Act and its implementing regulations, to determine the presence or absence of drugs. When a specimen tests positive on the initial screen, the positive test will be confirmed on the same sample by gas chromatography/mass spectrometry ( GC/MS ), liquid chromatography/mass spectrometry/mass spectrometry ( LC/MS/MS ), mass spectrometry/mass spectrometry ( MS/MS ) or an equivalent accepted method of equal or greater accuracy. 2. Sample Collection - Samples shall be collected and tested by individuals deemed qualified by the State Board of Health and may be collected on OCS s premises, worksites, including customer worksites, or at the facility designated by the notice to the applicant or employee. The collection of samples shall be performed under reasonable and sanitary conditions. A sample shall be collected in sufficient quantity for splitting into two separate specimens, pursuant to the rules of the State Board of Health, to provide for any subsequent independent analysis in the event of challenge of the test results of the main specimen. Samples shall be collected and tested with due regard to the privacy of the individual being tested. In the instances of urinalysis, no representative, agent, or designee of OCS shall directly observe an applicant or employee in the process of producing a urine sample; provided, however, collection shall be in a manner reasonably calculated to prevent substitutions or interference with the collection or testing of reliable samples. 3. Documentation Drug testing facilities shall use internal chain of custody procedures to maintain control of accountability of specimens from the time of collection of the specimen until the specimen is no longer required. 4. Test Results - A Medical Review Officer ( MRO ) who is qualified by the State Board of Health is responsible for receiving drug test results from the testing facility. The MRO has knowledge and
10 training to interpret and evaluate an individual s drug test results, as well as the individual s medical history and other relevant information. 5. Positive Test Result - Should an applicant or employee test positive to an initial and confirmatory drug test, the applicant or employee shall have the right to explain to the MRO, in confidence, any extenuating circumstances which may have caused the results of the test. VIII. TESTING PROCEDURES A. Notice to Report For Testing Verbal notification to an employee to report for testing may be accompanied by written notification. The written notification will specify the date, time, and place to report for testing. Each OCS applicant, employee will be educated as to this drug testing procedure including the sample collection process, privacy arrangements, drug testing procedures, and any other area necessary to provide applicants, employees with a general understanding as to the procedure. B. The Collection Site - After an applicant or employee has been identified for drug testing or alcohol testing (in the case of a test where an EBT device is not used), the process begins at a collection site. Designated collection sites will have all of the necessary personnel, materials, equipment, facilities, and supervision to provide for the collection, security, temporary storage, and transportation of test specimens to a designated drug testing laboratory. The collection site will use procedures that safeguard the applicant, employee s right to privacy, guard the integrity of the specimen, and maintain the chain of custody. C. Transportation To Collection Site - Individuals being tested for reasonable suspicion or accident testing will not be permitted to drive themselves and will be escorted to the collection site by an OCS representative. D. What To Expect At The Collection Site At the collection site, the applicant or employee will complete a form that requests specific questions about the use of over-the-counter medications for cold, cough, hay fever, and appetite suppression and other prescription medications which could test positive. The applicant or employee will be asked to provide a specimen. Procedures for sample collection will be followed as outlined in the previous section. E. Returning To Work Following Reasonable Suspicion Or Accident Testing - Individuals who are being tested for reasonable suspicion or accident testing will be temporarily suspended without pay pending the outcome of the test results.
11 F. Laboratory Testing - After the specimen is taken at the collection site for testing, it will be sent to a recognized State Board of Health laboratory where it will be tested for the substances previously listed in this Policy. G. Negative Results - If the laboratory results are negative, indicating the absence of drugs or alcohol, the process ends and the MRO will notify OCS by phone and in writing. H. Positive Results - If the laboratory results are positive on the initial screen, the positive test will be followed by a second test on the same sample to confirm the results. If the confirmatory test is positive, the MRO will contact the applicant or employee and give the individual an opportunity to explain the positive result in confidence. I. Recipient Of Drug Testing Results - The MRO or designated representatives of the MRO will be the sole recipient of testing results from the laboratory. J. Results Pending - Pending results of the confirmation test after an initial test is positive, an employee will be temporarily suspended. The individual will be given an opportunity to explain the results to the MRO. K. Consequences Of A Positive Test Result An applicant whose drug or alcohol confirmation test verifies the initial positive result may be refused employment. An employee whose confirmation test verifies the initial positive result will normally be subject to disciplinary action, up to and including discharge, and such discharge will be considered misconduct for purposes of unemployment compensation. L. Consequences Of Refusal To Submit To Testing - An applicant who refuses to submit to a drug or alcohol test will not be hired. An employee who refuses to submit to a drug or alcohol test will normally be subject to disciplinary action, up to and including discharge, and such discharge may be considered misconduct for purposes of unemployment compensation. M. Challenge To Positive Test Results - An individual whose confirmation drug or alcohol (in the case of tests where an EBT device is not used) test result is positive may request a re-test of the original sample in order to challenge the results of a positive test. An individual who requests a re-test of confirmation results in order to challenge the results of a positive test must pay the cost of the re-test. If, however, the results of the re-test reverse the findings of the
12 challenged positive test, OCS will reimburse the cost of the re-test to the individual. N. Confidentiality Of Test Results 1. Drug and alcohol testing will be conducted so as to reasonably ensure the confidentiality of the results. Test results and related information, including interviews, reports, statements, and memoranda shall be maintained as confidential information, separate from other personnel records. Such records, including the records of the testing facility, shall not be used in any criminal proceeding or any civil or administrative proceeding except in (1) those actions taken by OCS; (2) any action involving the individual tested and OCS; or in (3) such records are ordered released pursuant to a valid court order. 2. The records described in the above section and maintained by OCS shall be the property of OCS and, upon written request of the applicant or employee tested, shall be made available to the applicant or employee for inspection and copying. OCS shall not release such records to any person other than the applicant or employee tested, or the MRO, unless the applicant or employee in writing, following receipt of the test results, has expressly granted permission for OCS to release such records or pursuant to a valid court order. 3. Neither the testing facility (including any agent, representative, or designee of the testing facility); nor any MRO shall disclose to OCS, based on the analysis of a sample collected from an applicant or employee for the purpose of testing for the presence of drugs or alcohol, any information relating to: (1) general health, pregnancy, or other physical or mental condition of applicant or employee; (2) the presence of any drug other than the drug or its metabolites that OCS requested be identified and for which a medically acceptable explanation of the positive result, other than the use of drugs, has not been forthcoming from the applicant or employee; or (3) quantification of test results. However, the testing facility and/or the MRO may notify OCS whether the test was positive or negative for any substance identified in the Standards of Workplace Drug and Alcohol Testing Act and its implementing regulations. IX. DISCIPLINARY PROCEDURES
13 A. As part of this Policy, employees will normally be subject to disciplinary action, up to and including discharge, for any Prohibited Activity under this Policy. B. Employee Suspension - As part of this Policy, the following circumstances may result in an employee being suspended without pay, at the sole discretion of OCS: 1. Employees who are unable to work safely due to impairment resulting from legally prescribed drugs may be suspended (without pay), or required to use any available, paid leave, until the impaired condition has passed if the employee is unable to be temporarily transferred to another job until the impaired condition has passed. 2. Employees who are tested for reasonable suspicion or as a result of an accident will be suspended pending test results. If the test results are positive, the employee may be subject to disciplinary action, up to and including discharge. If the test results are negative, the employee will be reinstated immediately after the test results are confirmed and will be paid for the time away from work due to such suspension. All employees who are suspended from work will be paid for the balance of the first day of suspension but, unless otherwise indicated in this policy, will not be paid during the remainder of the suspension period. The suspension period will begin on the first full day not worked. Employees returning from suspension for violations of this Policy are subject to being substance tested before returning to work as previously described. X. RETURN TO WORK Employees who are permitted to return to work or their participation in OCS activities after testing positive for drugs or alcohol, participating in a drug or alcohol treatment program, or violating any other provision of this Policy will be required to execute a Return to Work Agreement. However, nothing in this Policy shall be construed to require OCS to allow an employee to return to work who has violated this Policy. This Return to Work Agreement will include, among other items, an agreement to unannounced screening for substance abuse, a statement of expected work-related behaviors, and an agreement never to use drugs (or alcohol) again. XI. EMPLOYEE ASSISTANCE PROGRAM ( EAP )
14 A. An employee who notifies OCS that he or she has a drug or alcohol problem prior to receiving notice of a drug or alcohol test conducted under this Policy will be referred by OCS to the EAP for evaluation. Any cost for treatment will be paid by the employee. If it is determined by the EAP that the employee is able to function safely in his or her job, the employee may continue to work while receiving treatment or counseling for the drug or alcohol problem. The EAP may also participate in execution of the Return to Work Agreement. If it is determined by the EAP that the employee is not able to function safely in his or her job, the employee will not be allowed to perform his or her job until the EAP determines that he is safely able to function in his job. Employees who are either required or self-referred to be assessed for substance abuse problems before returning to work are assured the content of any communication with the EAP is confidential within required need to know guidelines. Employees who request referral are assured of confidentiality. Only those in the chain of responsibility may be aware of the treatment request. B. The employee will be tested at the end of any treatment period and will be subject to the procedures and disciplinary actions outlined in this Policy. An employee who is tested at the end of a suspension period and tests positive may be subject to disciplinary action, up to and including discharge. C. Employees are accountable for performance. If an employee is experiencing performance problems or disciplinary action is pending, a request for help will be treated as a separate issue. Disciplinary amnesty will not be granted to employees asking for assistance and referral. However, disciplinary action may be deferred pending successful completion of a treatment process. Employees will not be dismissed solely on the basis of requesting help. D. A direct request by the employee for assistance prior to a positive drug or alcohol test will not be made part of the employee s personnel file. However, any related performance or disciplinary action may be documented. XII. USE OF LEGALLY OBTAINED DRUGS A. It is the responsibility of the employee to advise his supervisor of the necessity to take any medication containing a cautionary label regarding the operation of machinery or vehicles and of any Impairment. If necessary, a medical resource will be consulted to determine the potential for Impairment.
15 B. Employees Impaired as a result of their use of any legally obtained drug (prescription or non-prescription) may not be allowed to perform their regular duties or activities in such a condition. C. It will be considered an illegal drug and against OCS Policy to use a prescribed drug by any person other than the one for whom it is prescribed, to dispense a prescripton drug to another for whom it is not presecribed, to possess a prescription drug for another person who is not a minor dependent or elderly dependent, or to use a prescribed drug in a manner other than that which is prescribed if such use results in Impairment.
16 EXHIBIT A ACKNOWLEDGMENT OF DRUG AND ALCOHOL ABUSE POLICY AND TESTING PROGRAM I acknowledge that I have read and understand Oklahoma Christian School s (OCS) Employee Policy for a Drug and Alcohol Free Campus (the Policy ). I understand that, as an employee of OCS or an applicant who may become an employee of OCS, I may be subject to future testing, consistent with the Policy. I understand that a violation of the Policy may result in severe disciplinary action, up to and including discharge or the withdrawal of an offer of employment. I understand that the Policy is not a contract of employment and that it may be changed, modified, or eliminated at any time, with or without notice. I understand that my employment with OCS, if any, is at-will and for no fixed period of time. I understand that OCS can terminate my employment, if any, at any time at its sole discretion, with or without cause, and I may quit at any time, with or without notice. Signature Employee Name (print) Social Security Number Date Witness
17 EXHIBIT B NOTIFICATION TO REPORT FOR DRUG AND/OR ALCOHOL TESTING Name of person to report for testing: Type of Test If drug test, reason for drug testing (check one): Testing will occur at: Alcohol Test Drug Test (complete next section) Applicant Testing Employee Reasonable Suspicion Testing Employee Accident Testing Employee Scheduled, Periodic Testing Employee Post-Rehabilitation Testing Employee Random Testing Other Place: Date: Time: Name of Supervisor or notifying person: Signature of Supervisor or notifying person: DATE: ACKNOWLEDGMENT AND CONSENT I acknowledge that I have received this request for drug or alcohol testing on at. I consent to drug and alcohol testing, pursuant to Oklahoma Christian Schools Oklahoma Drug and Alcohol Abuse Policy and Testing Program. Signed: Witness: Date: Date:
18 EXHIBIT C SUPERVISOR S REASONABLE SUSPICION RECORD DRUG AND ALCOHOL TESTING (Complete for reasonable suspicion testing and post-accident or injury testing.) Section 1 Employee Name: Classification: Date of Observation: Time: am/pm Location: Section 2 Observations: COMPLETE SECTION 2 AND/OR SECTION 3 Check ALL that apply: BEHAVIOR stumbling, unsteady gait drowsy, sleepy, lethargic agitated, anxious, restless hostile, belligerent irritable, moody depressed, withdrawn unresponsive, distracted clumsy, uncoordinated tremors, shakes flu-like illness complaints suspicious, paranoid hyperactive, fidgety inappropriate, uninhibited behavior possessing, dispensing, or using controlled substances or alcohol APPEARANCE flushed complexion excessive sweating cold, clammy sweats eyes bloodshot tearing, watery diluted (large) pupils constricted pupils unfocused, blank stare unkempt grooming disheveled clothing BODY ODORS alcohol marijuana SPEECH slurred, thick incoherent exaggerated enunciation loud, boisterous rapid, pressured excessively talkative nonsensical, silly cursing, verbal abusiveness inappropriate response to questions or instructions
19 SUMMARY (circumstances, employee response, supervisor actions, other observations): The observations were made of the employee identified in Section 1. Supervisor Name Supervisor Signature Date Witness (optional, but preferred) Witness Name Witness Signature Date (If possible, have witness provide a separate statement on next page.) Additional Witness Statement: Section 3 A report of drug or alcohol use while at work or on duty was made of the employee identified in Section 1. Supervisor Name Supervisor Signature Date Reporting Individual Name Reporting Individual Signature Date Reporting Individual Statement: (If possible, have additional reporting individuals provide additional statements.) 2
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