14-Drug Free Workplace Form.pdf
PDF 92 KB Posted
- Attached to
- Marine Resource Assessment & Monitoring Services
- Solicitation number
- RFQ No. 2026-008
- Issued by
- Palm Beach County, Florida
About this file
This is a Drug Free Workplace Certification form for the Town of Palm Beach, Florida, required as part of the Marine Resource Assessment & Monitoring Services contract opportunity. The certification mandates that the grantee establish and maintain a drug-free workplace by publishing a statement prohibiting controlled substance use, establishing a drug-free awareness program, requiring employee acknowledgment of the policy, and implementing procedures for addressing violations. The form requires the authorized agent to certify compliance with all specified requirements, including notifying employees of penalties, maintaining records of drug-related convictions, and taking appropriate personnel action within 30 days of receiving notice of employee convictions related to controlled substances.
The certification serves as a compliance document that must be completed and signed by an authorized representative of the responding firm prior to contract award. The form captures the firm name, authorized agent information, and contact details, and requires both a wet signature and electronic signature. This is a mandatory requirement for all proposers responding to the Town of Palm Beach's request for qualifications for marine resource assessment and monitoring services, ensuring that any selected contractor maintains drug-free workplace standards throughout the contract period.
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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 .