Alcohol and Drug Program Administrative Guidelines

Transcription

1 Alcohol and Drug Program Administrative Guidelines Last Updated June 30, 2015

2 TABLE OF CONTENTS PART I: RAPID SITE ACCESS PROGRAM PROCESSES... 2 A. Enrollment in RSAP... 2 B. Random Testing... 2 PART II: TESTING PROCEDURES... 3 A. Collections for Site Access, Reasonable Cause, Post Incident, Random and Follow Up Testing and RSAP Enrollment Tests... 3 PART III: CASE MANAGEMENT... 5 A. Referrals for Violations... 5 B. Case Management... 6 C. Disagreement with SAE Outcome... 6 D. Ombudsman Process... 7 PART V: FREQUENTLY ASKED QUESTIONS... 7 A. RSAP... 7 B. Violations... 9 C. Referrals... 9 D. SAE and Case Management E. Return to Work (RTW) PART VI: ACRONYMS AND DEFINITIONS A. Acronyms B. Definitions PART VII: CONTACT INFORMATION APPENDICES Alcohol and Drug Program Administrative Guidelines Page 1

3 PART I: RAPID SITE ACCESS PROGRAM PROCESSES A. Enrollment in RSAP [see Appendix 1] Enrollment steps Worker registers to be a RSAP Participant Worker on Enrollment Test Negative Result Enrollment Test Positive Result B. Random Testing [see Appendix 2] OHI contacts worker to determine what steps are required for enrollment Enrollment may be granted with one of the following: o The worker has had an A&D test with a negative result within the last 90 days and is currently working on a RSAP participating site. This test is considered grandfathered and allows the worker to go directly into the random testing pool [OHI to request results from contractor]; or o The worker has had an A&D test with a negative result within the last 90 days, is not currently working on a RSAP participating site and the Union Hall has provided OHI with an Assumed Negative Letter for the worker [OHI to request from the Union]; or o An enrollment test is taken through CannAmm [OHI to book with CannAmm]. See Alcohol and Drug Testing Procedures in the Canadian Model for more specific testing protocols Worker is accepted as RSAP Participant and is assigned an RSAP Participant ID number and placed into random testing pool draws. Worker is not accepted as an RSAP Participant. Worker is required to take another enrollment test if he/she decides to enroll into RSAP. Worker s name drawn for testing Worker placed on the testing list, collection of a sample will be attempted within that month. The collector will attend the worksite that the worker is listed to be working at as per the Unions dispatch systems, providing approximately 1 hour of notice to the foreman or supervisor. Alcohol and Drug Program Administrative Guidelines Page 2

4 Sample Collection A breath alcohol test is conducted first to screen for alcohol. The second portion of the test will be oral fluid completed under direct observation for the drug portion of the test. The oral fluid is sent to the laboratory for results. If the sample is negative, the worker is placed back into the random testing pool. If the sample comes back as a confirmed positive result, then the worker is classified as inactive. PART II: TESTING PROCEDURES A. Collections for Site Access, Reasonable Cause, Post Incident, Random and Follow Up Testing and RSAP Enrollment Tests Note: Parts II and III are applicable to all workers, not only RSAP Participants, unless otherwise noted. Sample collection breath alcohol test Sample collection urine test A breath sample is collected to test for the presence of alcohol. If the test result is less than the threshold outlined in the Canadian Model, then no further testing is required. If the test result is greater than the threshold outlined in the Canadian Model, then an additional breath sample will be required for confirmation of a positive test result. The sample for RSAP Enrollment/RTW/Follow up/site Access will be urine based and evaluated by the collector for the following: 1. Temperature Out of Range; 2. Tampering or adulteration of substance; 3. Volume; 4. Unusual colour; 5. Unusual odour; and 6. Presence of foreign objects or material. If any of the above are evident in the sample, a second sample will be collected. If donor refuses to comply with collection prior to the 3 hour shy bladder protocol, it will be deemed a refusal to test. If, after the 3 hour period no sample has been provided, the MRO will determine the test result following consideration of any medical information. Alcohol and Drug Program Administrative Guidelines Page 3

5 Sample collection oral fluid test If sample provided is temperature out of range (TOR) [#1 above] a second collection under direct observation [by a collector of the same gender] will be required. If donor refuses to comply with collection, it will be deemed a refusal to test. Sample collected for random, reasonable cause, post incident. Collection by direct observation. Shy mouth protocol allows for the option of the donor providing a urine sample if they are unable to provide an oral fluid sample. Worker not on shift Collector will attempt collection at a later date, worker s name carries forward on to the following month s testing list until sample is obtained [applies to follow up and random testing only]. Worker unable to provide sample Worker refuses to provide sample If a worker is not be able to provide an oral fluid sample due to shy mouth, shy mouth protocols will be used. If the shy mouth protocols are not successful then a worker may provide a urine sample. Shy bladder protocols will be used if the worker is unable to provide a urine sample. If the worker refuses to provide a urine sample, he/she will be recorded as a refusal [see below]. Refusal to provide a sample will result in the worker to be classified inactive. The contractor, or in some cases the union, will submit a referral for the worker [see Referrals for Violations Process in Part III]. *Note: may be used as a risk assessment tool in some circumstances Point of Collection POCT is used only as a risk assessment tool and is not a lab based Testing (POCT) alcohol /drug test Used only for reasonable cause or post incident Alcohol and Drug Program Administrative Guidelines Page 4

6 PART III: CASE MANAGEMENT A. Referrals for Violations [see Appendix 3] Referral Process A worker with a confirmed positive test result will be referred to OHI by the contractor for a SAE. Substance Abuse Expert (SAE) Assessment Prior to SAE Assessment and Debriefing of the SAE Assessment The contractor is responsible for completing and submitting the referral for all Canadian Model violations [see Section of the Canadian Model]. The referral is submitted by completing the referral form found under the heading A&D Violation Referral on [ for Boilermakers]. OHI will assign a case manager and contact the worker within 1 business day of the referral being submitted. The worker is classified as inactive and will be ineligible for all dispatches due to the violation [see section 5.5 of the Canadian Model] if their union has signed the Referral for Managed Aftercare letter. OHI sends an Inactive Status Letter to the union hall and the contractor. A worker must complete the SAE Assessment within 120 days of the referral to be eligible for funding from CEFAP. A SAE Assessment completed after 120 days will not be funded by CEFAP under any circumstances and the worker will be responsible to pay the cost of the Assessment. Diagnosis and treatment recommendations will be specified in the SAE Assessment Report following the Assessment. The worker will receive a verbal report from Homewood Health. A written report will also be provided to the worker if he/she requests it from Homewood Health. A worker may have a Union Designate attend the pre and post SAE Assessment briefing with him/her. A consent form for Union Designate Attendance must be completed by the worker and sent to Homewood Health. The Union Designate must have participated in the training courses Understanding Our Canadian Model and the Alcohol and Drug Workshop for Union Designates. Alcohol and Drug Program Administrative Guidelines Page 5

7 B. Case Management [see Appendices 4, 5, and 6] Worker completes case management conditions as per SAE Assessment Worker does not complete case management conditions as per SAE Assessment OHI facilitates return to work with the worker. The worker must be in compliance with the Return to Work Agreement (RTW) which is signed by the worker. Recommendations stated in the Assessment may be in two parts: those requisite to returning to work, [in/out patient treatment, post assessment counselling (PAC) and/or a return to work alcohol and drug test] as specified in the SAE Report; and any additional requirements for remaining at work [PAC and followup testing]. Return to work plan is developed by OHI using the SAE Report; the report outlines recommendations and treatment program. Worker s status is classified active as determined by OHI as per the recommendations stated in the SAE report and RTW agreement. OHI will send the Active Status Letter to the union and the contractor who had submitted the referral. Worker remains classified as inactive and will not be eligible for dispatch until recommendations are met. C. Disagreement with SAE Outcome [see Appendix 7] Options for the worker A worker who disagrees with the diagnosis and/or recommendations in his/her SAE Report, can choose to pursue either an independent review or a second assessment. Both options are at the cost of the worker. Independent Review An Addictions Physician, as selected and approved by CLR, BTA, and Homewood Health, will review the SAE Assessment Report and make a determination regarding the diagnosis and/or recommendations. The worker must follow these outcomes to regain active status. Second Assessment An Addictions Physician, as selected and approved by CLR, BTA, and Homewood Health, will complete another SAE Assessment and provide a report with a diagnosis and recommendations. Alcohol and Drug Program Administrative Guidelines Page 6

8 If the second assessment diagnosis and recommendations differ from the initial assessment, then the assessor that completed the initial assessment, as well as Homewood Health s Addiction Physician Consultant will discuss discrepancies and agree on a course of action. If the worker accepts this outcome, then he/she moves forward with completing recommendations. If the worker does not accept this outcome, he/she may then engage the ombudsman process for a final decision. D. Ombudsman Process [see Appendix 7] Ombudsman Review Client engages Ombudsman to review the outcome of the second assessment. The fee for this review is at the worker s expense. PART V: FREQUENTLY ASKED QUESTIONS A. RSAP 1. What are the advantages of being a RSAP participant? A worker who is an active RSAP participant is able to get to work on an RSAP participating sites quicker as they are not required to complete a pre-access alcohol and drug test prior to going to site. 2. What are the advantages of being a RSAP participating site? An RSAP participating site permits an RSAP participant who is classified active to have site access without the requirement of a site access test. The worker agrees, as an RSAP participant, to random testing as stipulated in the RSAP Procedural Rules. 3. Why aren t all sites RSAP participating sites? Participation for sites, just as it is for workers, is voluntary. As a result, some sites have chosen, for various reasons, not to participate in RSAP at this time. However, we continue to recruit and sign up new sites regularly. 4. Can workers be required by the owner or contractor to sign up for RSAP? No, RSAP is a voluntary program, there is no requirement to sign up. Alcohol and Drug Program Administrative Guidelines Page 7

9 5. Can a RSAP Participant opt out of their RSAP membership? Yes, a participant can opt out of RSAP provided that they: have active status; are not currently in case management are not currently employed with a RSAP participating contractor and site; and submit a signed and dated opt out letter to OHI. 6. What happens when an RSAP participant works in a non-participating site? When a RSAP participant goes to work at a non-participating site, the worker must submit to any owner-required site access test, and will be removed from the random testing pool draw for the duration of time spent working on the nonparticipating site. The worker s RSAP status will be classified as administratively inactive. If the worker remains administratively inactive for a period of 6 consecutive months or more, the worker must submit to a re-qualification test prior to being dispatched to a RSAP participating site for a RSAP participating contractor. 7. How does random testing work? A monthly list is randomly generated by the RSAP software. With this list, the collector will attend the sites with a mobile testing unit and conduct the tests utilizing the breath alcohol test and oral swab [drug] methods for the random draw. The oral swab collection sample will be sent to the laboratory for screening and confirmation of the results. 8. How long does a worker who failed his/her RSAP enrollment test need to wait before being retested? There is a 90 day waiting period to qualify for another test for enrollment. 9. How many times can an RSAP participant expect to get tested per year? RSAP aims to test 4.17% of the RSAP participants per month. RSAP participants are those who are working for a participating contractor on a participating site. A randomly generated list will identify those individuals who will be required to submit to testing. The equivalent of 50% of the RSAP participants will be tested every year; however, because testing is completely random, RSAP participants may be tested multiple times in one year, or not at all. 10. Would a RSAP participant ever be subject to random testing at home or on days off? No, all random testing is done at the worksite, during work hours. Alcohol and Drug Program Administrative Guidelines Page 8

10 11. What if the RSAP participant is working on a non-participating RSAP site when his/her name is selected for random testing? The RSAP participant s name will be removed from the random testing pool for the duration of time spent working on the non-participating site. 12. Under what circumstances is a RSAP participant tested, outside of his/her enrollment test? When his/her name comes up in the random testing pool; When there is reasonable cause to suspect that the individual is under the influence of alcohol or drugs at work; Following involvement in a safety incident at work; or Follow-up testing if the RSAP participant is involved in case management. B. Violations 13. What is considered a violation for the purposes of a referral to OHI? Any Canadian Model violation, as outlined in 3.1 Alcohol and Drug Rule. C. Referrals 14. When is a referral required? A referral is required when a worker has a violation under the Canadian Model which can result from the following circumstances: Site access test [new site or transferring sites]; Post incident; Reasonable cause; Follow-up test; Camp infraction; Travel infraction; Refusal to test; Self-disclosure; Use, possess, or offer for sale, any product or device used to tamper with an alcohol or drug test [drug paraphernalia]; Failure to disclose use of prescription or non-prescription drugs while at work; or Use of prescription or non- prescription drugs while unfit for work. 15. Is a referral required if the RSAP participant enrollment test was failed? No referral will be submitted for a failed enrollment test. 16. When would a Union complete a referral form for a RSAP participant? When a worker has made a request under self-help to the Union, the Union is responsible for completing the referral form. Alcohol and Drug Program Administrative Guidelines Page 9

11 17. Why is the Contractor responsible for completing the referral for a worker who has tested positive on a pre-access test? The pre-access test is an owner s requisite to employment on a particular site and the test was requested by the contractor for employment purposes therefore, the contractor is responsible for the referral. 18. Under what circumstances would a referral not meet the criteria for case management? Non-mandatory case management trade [union does not consent to case management]; Camp/travel infraction [worker does not consent to case management]; or Self-disclosure [worker does not consent to case management]. D. SAE and Case Management 19. Which unions do not have mandatory case management? Boilermakers, Bricklayers General, Elevator Constructors, Sprinkler Fitters, Glassworkers, Roofers, and Tilesetters. 20. What happens with workers who are not subject to mandatory case management? Workers who belong to a union which has not signed the Referral for Managed Aftercare Letter of Understanding can still receive case management if the worker and their union provide consent. All RSAP participants are subject to mandatory case management in the event of a Canadian Model Violation, in accordance with the RSAP agreement the worker signed when he/she joined the program. 21. Is the worker able to bring anyone with them into the SAE Assessment? No, the worker must attend the SAE Assessment alone; however, they are permitted union representation from a Union Designate during the pre/post SAE briefings. The Union Designate must have participated in the appropriate training [ Understanding Our Canadian Model and Alcohol and Drug Workshop for Union Designates ]. 22. Is abstinence a recommendation in all cases? No, a recommendation of abstinence is based on a number of factors as determined by the diagnosis. 23. What locations are the SAE Assessments available in? There are several locations available. SAE Assessments can be completed in all regions of Canada. Alcohol and Drug Program Administrative Guidelines Page 10

12 24. When is residential treatment recommended? A recommendation of residential treatment is based on a number of factors as determined by the diagnosis. 25. Does the worker get a copy of the SAE findings? Does anyone else receive these findings? The worker is entitled to a copy of their SAE Report upon request to OHI and may share it with anyone they choose. E. Return to Work (RTW) 26. When is the RTW meeting held? RTW meetings are scheduled after the worker has completed treatment as determined by his/her diagnosis from the SAE. 27. Where are the RTW meetings held? These meetings are held in one of the Organizational Health Inc. (OHI) Offices. 28. Who attends? The OHI Case Majnager and the worker attend the RTW meetings. 29. What is involved in aftercare services? Follow up testing in accordance with the RTW agreement; Compliance monitoring this could include contact with worker, counselling, abstinence, A&D test results, additional supports as needed; Monitoring of end date and release by OHI case manager; and Could also include relapse prevention sessions, other meetings and counselling to support abstinence. 30. Would a worker who is in case management ever be subject to testing at home or on days off? As per the return to work agreement, a worker may be required to submit to offsite follow up testing which may occur outside of work hours. 31. Is the worker required to comply with the Return to Work Agreement to be eligible for active status? Yes, the worker must be in compliance with the Return to Work Agreement (RTW) which is signed by the worker. The RTW plan is developed by OHI using the SAE report which outlines recommendations and the treatment program. Recommendations stated in the SAE report may be in two parts: those requisite to return to work, [in/out patient treatment, post assessment counselling (PAC) and/or a return to work alcohol and drug test] as specified in the SAE Report; and any additional requirements for remaining at work [PAC and follow-up testing]. Alcohol and Drug Program Administrative Guidelines Page 11

13 PART VI: ACRONYMS AND DEFINITIONS A. Acronyms BAT Breath Alcohol Test CCF Custody and Control Form CEFAP Construction Employee and Family Assistance Program DER Designated Employer Representative DUR Designated Union Representative FU On-Site Follow Up On-Site FU Off-Site Follow Up Off-Site OC Observed Collection PAC Post Assessment Counselling RTW Return to Work SAE Substance Abuse Expert TOR Temperature Out of Range TPA Third Party Administrator B. Definitions Active status Administratively inactive Alcohol and drug test Alcohol and drug work rule Assumed negative letter Case manager A worker who has provided a negative A&D test result and is able to be dispatched. A RSAP participant who is or has been working for a non RSAP participating contractor or site for a period of 6 months, and who is therefore not included in the random testing pool. A test administered in accordance with section 4.8 of the Canadian Model. The alcohol and drug work rule set out in section 3.1 of the Canadian Model. In lieu of an enrollment test, a letter is provided by the Union to OHI confirming that a worker has had an A&D test with a negative test result within the last 90 days. This letter is provided at OHI s request when a worker has applied to be a RSAP participant and is not currently working on a RSAP participating site. A professional with training, knowledge and experience in case management and substance abuse disorders. The case manager facilitates and confirms compliance with treatment recommendations, and provides supportive and objective case management services, including oversight of aftercare and return to work conditions recommended by the SAE, to support the worker and maintain the safety of the worker and those around him/her on a safety-sensitive work site. Alcohol and Drug Program Administrative Guidelines Page 12

14 Employee assistance services program Inactive status Inactive status letter Negative test result Positive test result Safety advisory Substance abuse expert (SAE) Union Designate Services that are designed to help employees who are experiencing personal problems such as alcohol and drug abuse. A worker who is unable to be dispatched due to a Canadian Model violation or failure to complete the recommendations arising from an SAE Assessment and/or return to work agreement. The letter sent by OHI to the union and the contractor notifying them of a worker s status being changed to inactive. A worker who has provided a specimen for alcohol and drug testing [laboratory-based] which did not have an alcohol and drug concentration level equal to or in excess of that set out in section 3.1(b) of the Canadian Model. A report from the Medical Review Officer that the employee who provided a specimen for alcohol and drug testing [laboratory-based] did have an alcohol or drug concentration level equal to or in excess of that set section 3.1(b) of the Canadian Model. Potential safety risk of this individual performing safety sensitive job functions. The worker will require an evaluation of a physician to determine the individual s fitness for duty. A licensed physician; a licensed or certified social worker; a licensed or certified psychologist; a licensed or certified employee assistance expert; or an alcohol and drug abuse counsellor. He or she has received training specific to the SAE roles and responsibilities, has knowledge of and clinical experience in the diagnosis and treatment of substance abuse-related disorders, and has an understanding of the safety implications of substance use and abuse. A Union Representative who has been specifically trained to attend the pre/post SAE Assessment and RTW briefings to assist the worker in understanding the Assessment and RTW processes. PART VII: CONTACT INFORMATION OHI Homewood Health CannAmm CLR (CEFAP) Alcohol and Drug Program Administrative Guidelines Page 13

15 APPENDICES 1. Process Map RSAP Enrollment 2. Process Map RSAP Random Testing 3. SAE Assessment What to Expect? 4. Process Map - Case Management 5. Union Designate Attendance Request Form Homewood Health [Briefing and Debriefing of SAE] 6. Union Designate Attendance Request Form - OHI (Return to Work) 7. Process Map Disagreement with SAE Outcome Alcohol and Drug Program Administrative Guidelines Page 14

16 Appendix 1 - RSAP Enrollment Process Managed by CLR and OHI Register at OHI contacts worker OHI requests assumed negative letter from union OHI requests A&D results from previous contractor if <90 days old OHI schedules enrollment test Negative test result Positive result, cancelled test, or refusal Enrolled in RSAP and placed in random test pool Second enrollment test after 90 days Union Hall notified of RSAP Member Active Status Rsap.ca updated to reflect RSAP Member Active Status OHI Provides Active Status letter to Participating Contractors as requested

17 Appendix 2 RSAP Random Testing Process Managed by CannAmm Name is drawn from random test pool Collector attends site to obtain sample Worker unable to provide sample Worker not on shift Worker refuses test Worker provides sample Worker returns to site until results are obtained Tester to utilize shy mouth or shy bladder protocol Collector attends site to obtain sample* Fail test Pass test * Worker remains on testing list until the sample has been collected Worker s status becomes inactive Worker goes back into random testing pool Worker is removed from site

18 Who is the SAE Expert? Substance Abuse Expert (SAE) Assessment: What to expect? The Substance Abuse Expert (SAE) is a person whom you will meet with as part of the SAE Assessment. The SAE conducting the assessment: -may be a licensed or certified professional: licensed physician, registered psychologist, or a certified, registered, or licensed social worker and is able to diagnose as outlined in their provincially regulated health professional guidelines; -has met the educational, experiential, & competency criteria to be in good standing with a professional agency that governs their respective discipline; -has received training specific to the SAE roles and responsibilities, has knowledge of and clinical experience in the diagnosis and treatment of substance abuse-related disorders, and has an understanding of the safety implications of substance use and abuse. The responsibility and function of the SAE is: -to apply quality & diligence in the assessment process in order to protect your safety & the workplace s safety & health; -not an advocate for any stakeholder in the process beyond the mandate of the assessment, rather they are to remain impartial. What can you expect during the assessment? Please arrive 15 minutes early for your appointment to complete the required paperwork prior to the start of your appointment, including consent for the assessment and a release form for us to share the results of your assessment. Without the signed consent and release, we will not be able to proceed with the assessment. You will be asked to turn off or power down all electronic devices. The SAE will ask you to do this in their presence. The SAE Assessment will not proceed if you do not agree to this. Your assessment appointment will be scheduled for 2 hours. The clinical interview will cover the reason for referral and review your functioning in various areas of your life. The face to face interview includes assessment of all the relevant factors that are known to be essential in the evaluation of individuals with possible substance use disorders. You will be asked to complete a pen and paper questionnaire. This questionnaire can take anywhere between 10 to 30 minutes to complete. There are no right or wrong answers; please answer all the questions to the best of your ability. The SAE will schedule a date and time for a 15 minute telephone appointment following the assessment. This debrief call will review the results of the assessment and the treatment recommendations. What to expect after the assessment appointment? Upon leaving the SAE s office, the following occurs: Pen and paper questionnaire that you completed will be reviewed and the final SAE report will be prepared SAE will consult with a Homewood Health Clinical Manager A report will be written; listing recommendations about your return to work based on the results of the assessment and sent to those individuals identified on your signed Release of Information. Please note: Our standards stipulate the report will be forwarded within 5 business days (end of day) after your assessment appointment. There are instances when the report may not be ready to be sent due to additional information we require or additional consultations. In this instance, the assessor will call you at the scheduled debrief time and advise you that the report may be delayed up to an additional 5 business days. These occurrences are not common but they do occur. V5.01/08/2015 1

19 The SAE assessment will provide a clear statement of the assessment s outcome (the diagnosis), along with treatment recommendations. These recommendations typically involve treatment options such as education, counselling or inpatient treatment services, follow- up testing, and general conditions of post assessment care. Before the final assessment report is released, the assessor will debrief you on the results of the assessment and the treatment recommendations (scheduled date/time established at the time of the SAE Assessment). o We ask that you be available at that time. o Please have a pen and paper handy to take down the exact information. o If you do not answer, the SAE will attempt to call you several times within a span of 1-2 hours. If there is no answer, the SAE will leave you a voice mail message only if you previously indicated that it is acceptable. The message will outline the attempts made to reach you and that the report will be sent to those individuals identified on your signed Release of Information. o It is unlikely that the assessor will be available outside the prearranged debrief time. In the event you missed the scheduled debrief, please do not contact the assessor directly. You will need to call the Homewood Health Client Services Center at and request a callback to discuss the assessment results with either the SAE or a Clinical Manager. The final report will be released to your case manager, other designates and the individual assessed (if they requested a copy with the diagnosis and treatment recommendations). This includes any recommendations arising from the results of the assessment, for reasonable accommodations and/or treatment to assist you to either remain at work, or to return to work. If you have any questions before, during, or after the assessment process, please contact the Homewood Health s Assessment Intake Team at They will connect you with the most appropriate person to answer your questions. What to expect after I have been debriefed and the SAE report has been sent to my case manager and/or other designates? Once you receive the assessment results and the recommended treatment, there are several things that you are required to do in order to get back to work quickly: Seek out the resources that you need to meet the recommendations that the SAE outlined during the debriefing phone call. If you are engaged in case management, please contact them to review next steps. Note: they will likely have the SAE report only hours after your debrief call with me. If you are not engaged in case management, contact the Homewood Health Client Service Centre at to schedule your recommended substance use counseling sessions (if this was the treatment recommendation). We hope this information is helpful to you. If you have any additional questions regarding the SAE process, please contact Homewood Health s Assessment Intake Team at They will answer your question or connect you with the appropriate person to answer your questions. Thank you, Homewood Health SAE Assessment Team V5.01/08/2015 2

20 Appendix 4 Case Management Managed by Homewood Health Worker referred for SAE by OHI Worker refuses SAE Worker completes SAE Worker remains on inactive status Worker refuses case management Worker participates in case management Worker does not complete case management conditions as per SAE assessment Worker completes case management conditions as per SAE assessment Worker s status changed to active

21 Appendix 5 Attendance Request Form Substance Abuse Expert Services UNION DESIGNATE ATTENDANCE - REQUEST FORM I, /, (Name of Union Member/Client) (Date of Birth, mm/dd/yyyy) request and agree to have (Name of Union Designate) attend my briefing and debriefing portions of my Substance Abuse Expert (SAE) Assessment. I understand that: 1) My Union Designate must be on the list of Approved Designates to attend. No substitute designates or other parties may attend. 2) My Union Designate can attend the briefing prior to my SAE assessment and the debriefing following my SAE assessment to review the processes and requirements that may result from my SAE assessment. 3) My Union Designate shall not attend the interview or testing portion of my SAE assessment. 4) Diagnosis and/or recommendations are not yet available and shall not be discussed during the SAE assessment appointment. 5) My Union Designate can attend my telephonic debriefing of the results of the SAE report. Note: Part of the assessment booking process is an eligibility check where you may be required to provide employment information, the Alcohol and Drug Custody Control Form and an initial consent form (if previous history with Homewood Health is not identified). Furthermore, I understand that once this form is submitted, a SAE intake counsellor will contact me to initiate the assessment booking process. I also understand that due to the nature of this appointment, the 2 day service standard for booking does not apply. Client Name (please print) Union Designate Name (please print) Client Contact Telephone Number Union Designate Contact Telephone Number Signature Signature Date Signed (mm/dd/yyyy) Date Signed (mm/dd/yyyy) Please return completed form by fax: or saeftwadmin@homewoodhealth.com The client may cancel this request at any time with written notice to the above noted fax or . 02/18/15 rev.4

22 Appendix 6 Union Designate Attendance Request Form UNION REPRESENTATIVE ATTENDEE- REQUEST FORM I, _,, (Name of Union member) (RSAP ID) (Date of Birth, mm/dd/yyyy) request and agree to have attend my briefing, instruction and debriefing (Name of union representative, designated) portions of the Return to Work Meeting (RTW). I understand that: 1) My union designate must be on the list of approved designates to attend. No substitute designates or other parties may attend. 2) My union representative can be present for the briefing/instruction portion of my RTW meeting. 3) My union representative cannot partake in the discussion of the SAE Assessment Diagnosis and/or recommendations as per the RTW agreement as this discussion will occur only between myself and the OHI Case Managers present. 4) Once the RTW Agreement is signed, my union representative can be present for the debriefing portion of the RTW meeting. Furthermore, I understand that once this form has been submitted, I will need to contact my OHI Case Manager, to coordinate the RTW meeting booking between myself the OHI Case Manager and the Union Designate.. Union member Name (please print) Union Representative Name (please print) Union member contact information (phone #) Union Rep. contact information (phone #) Signature Signature Date Signed (mm/dd/yyyy) Date Signed (mm/dd/yyyy) Please return completed form to us by fax or rsap@ohiinc.ca or Fax: The client may cancel this request at any time with written notice provided to the Organizational Health office at fax /02/15 rev.2