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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2019 | 4.1 Satisfied (52 Votes) |
The form requires the employer's name, insurance policy number, address, contact person, and phone number.
Employers must indicate which types of drug tests are conducted, including options for post-job offer, reasonable suspicion, return to duty, post-accident, and random testing.
Employers must check all applicable methods of notifying employees about the drug-free workplace policy and testing procedures.
The form includes sections for employers to indicate if they provide employee assistance programs or educational seminars related to drug-free policies.
Employers are required to provide the name of the Medical Review Officer (MRO) and the DHHS-certified laboratory conducting the tests.
The form includes a certification statement that must be signed by an officer or owner of the company affirming that the information provided is accurate.
A notary public's signature is required on the form to validate the certification of the drug-free workplace program.
