1-Drug Free Workplace Form.doc
DOC document 27 KB Posted
- Attached to
- Maintenance of Medical Equipment
- Solicitation number
- ITB-26-00293
- Issued by
- Hillsborough County, Florida
About this file
This is a Drug-Free Workplace Certification Form required by the Hillsborough County Board of County Commissioners in Florida for the Maintenance of Medical Equipment contract opportunity. Vendors bidding on this contract must complete and submit this form to demonstrate compliance with Florida Statute 287.087. The form serves as a binding certification that the bidding contractor maintains a drug-free workplace policy and has implemented mandatory procedures including publishing workplace drug prohibition statements, informing employees of drug abuse dangers and available assistance programs, distributing policies to all employees engaged in the contract work, and requiring employees to report drug-related convictions within five days. The contractor must also impose sanctions or require participation in drug abuse assistance or rehabilitation programs for any employee convicted of drug violations and make good faith efforts to maintain compliance with these requirements throughout the contract term.
The Drug-Free Workplace Form requires the authorized company representative to sign and date the certification, attesting that the firm fully complies with all six statutory requirements outlined in Florida Statute 287.087. This certification is a mandatory submittal for the estimated $80,000 medical equipment maintenance contract with a two-year term. Failure to complete and certify this form may result in bid rejection or contract termination. The form contains no pricing information, as it functions solely as a compliance and policy attestation document required as part of the bidding process for state and local government contracts in Florida.
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Text version
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that
________________________________________________________ does:
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business’ policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 1893 or of any controlled substance law of the United States or any state, for violation occurring in the workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program, if such is available in the employee’s community, by any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.
Offeror’s Signature
Date
DRUG-FREE WORKPLACE FORM
G:\Forms Library\0500-Forms\522_Drug Free Workplace Form.doc
File details come from the government source that posted it. Updated .