12-TOPB Drug Free Workplace Form.pdf
PDF 92 KB Posted
- Attached to
- Automated External Defibrillators (AED)
- Solicitation number
- ITB No. 2026-007
- Issued by
- Palm Beach County, Florida
About this file
The document is a Drug-Free Workplace Certification form from the Town of Palm Beach, outlining comprehensive requirements for maintaining a drug-free workplace for grantees and contractors. The certification mandates seven key provisions, including publishing a statement prohibiting controlled substance activities in the workplace, establishing a drug-free awareness program, providing employees with written statements about drug policies, and requiring employees to notify employers of any workplace drug-related criminal convictions.
The form requires firms to take specific actions when an employee is convicted of a drug-related workplace offense, such as taking personnel action (including potential termination) or requiring the employee to participate in an approved drug rehabilitation program. The document serves as a formal certification that the firm will comply with these requirements, with space provided for the authorized agent to complete firm details, contact information, and provide a signature. This certification appears to be a standard requirement for firms seeking to work with the Town of Palm Beach, ensuring a safe and drug-free work environment across municipal contracts and grants.
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Text version
TOWN OF PALM BEACH
DRUG FREE WORKPLACE
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS The grantee certifies that it will provide a drug-free workplace by:
1. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;
2. Establishing a drug-free awareness program to inform employees about—
a. The dangers of drug abuse in the workplace;
b. The grantee’s policy of maintaining a drug-free workplace;
c. Any available drug counseling, rehabilitation and employee assistance programs, and
d. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace.
3. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (1);
4. Notifying the employee in the statement required by paragraph (1) that, as a condition of employment under the grant, the employee will—
a. Abide by the terms of the statement; and
b. Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after each conviction;
5. Notifying the agency within ten days after receiving notice under subparagraph (4b) from an employee or otherwise receiving actual notice of such conviction;
6. Taking one of the following actions, within 30 days of receiving notice under subparagraph (4b), with respect to any employee who is so convicted—
a. Taking appropriate personnel action against such an employee, up to and including termination; or
b. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
7. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs 1, 2, 3, 4, 5, 6.
As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.
Firm: Date:
Authorized Agent: Title:
Email: Phone:
Signature:
| Firm: |
| Date: |
| Name: |
| Title: |
| Email: |
| Phone: |
| eSignature: |
File details come from the government source that posted it. Updated .