Attachment 3 Reference Materials_Online ASR screens.pdf

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DFWP ASR/Archive

Annual Summary Report Instrument, FY 2021

History/Description of the Annual Summary Report (formerly known as the Annual Survey Report)

The Federal Drug-Free Workplace Program (DFWP) was established by Execu�ve Order 12564 in 1986 and Public Law 100-71 in 1987 to address illicit drug use by federal employees. The Execu�ve Order requires all Execu�ve Branch agencies to develop a plan for a drug-free workplace that includes employee assistance, supervisor training, employee educa�on, and drug tes�ng. The Public Law requires the Department of Health and Human Services to cer�fy agency Drug-Free Workplace Program plans and to issue the scien�fic and technical guidance, which are now the Mandatory Guidelines for Federal Workplace Drug Tes�ng Programs.

The Annual Survey Report (ASR) was developed following the issuance of Execu�ve Order 12564 in 1986 to monitor the progress of federal Execu�ve Branch implementa�on of the DFWP. Data were ini�ally collected semi-annually, and later on an annual basis. The data collec�on was moved to a web-based system in 2001. In 2017, the report was streamlined, the repor�ng system pla�orm was upgraded and enhanced, and the name was changed to Annual Summary Report.

The ASR remains the single longitudinal dataset describing federal agency DFWP ac�vity. The purpose of the ASR is to track program implementa�on over �me and to inform future program direc�on at the agency and federal program levels.

The ASR is a tool that provides:

Data on the policy and plan por�on of the DFWP An overview of program status and implementa�on of the DFWP for program monitoring Agency profiles for tracking purposes Program descrip�on and opera�ons; program profile and results Annual reminder to agencies about the program

*NOTE:*

Data entered on this form should pertain to the period from October 1 to September 30 of the requested fiscal year.

*CAUTION* Unless you have clicked the op�on to "Keep me signed in" when logging into Microso� services, inac�vity in the system will cause the system to �meout a�er 5 minutes, and data could be lost. Please remember to SAVE your data o�en to avoid loss of data.

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Operations Profile

Date Informa�on Entry Began:

Fiscal Year of Data Reported: 2021 Repor�ng Period: October 1 - September 30

1. During this repor�ng period, were all components of your agency’s plan/program fully implemented (fully available)?

a. Employee Assistance Program Yes No

b. Supervisor Training Yes No

c. Employee Educa�on Yes No

d. Drug Tes�ng Yes No

2. Do any restric�ons or injunc�ons pertain to the tes�ng program?

Yes No

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Page 2 of 10 Opera�ons Profile

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Drug-Free Workplace Program Plan

3. During this repor�ng period, was your agency's Drug-Free Workplace Program plan reviewed?

Yes No

4. During this repor�ng period, was your agency's Drug-Free Workplace Program plan updated?

Yes No

5. To my knowledge: My agency’s DFWP plan is:

a. Current:

Yes No Don't Know

b. Complete:

Yes No Don't Know

c. Accurate:

Yes No Don't Know

d. Consistent with the current HHS Model Plan and current HHS Mandatory Guidelines for Drug Tes�ng:

Yes No Don't Know

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Testing Designated Positions (TDPs)

6. During this repor�ng period, was your agency's TDP list reviewed according to the Guidance for Selec�on of Tes�ng Designated

Posi�ons?

Yes No

7. During this repor�ng period, was your agency's TDP list updated according to the Guidance for Selec�on of Tes�ng Designated

Posi�ons?

Yes No

8. To my knowledge: My agency’s TDP list is:

a. Current:

Yes No Don't Know

b. Complete:

Yes No Don't Know

c. Accurate:

Yes No Don't Know

d. Consistent with the Guidance for Selec�on of Tes�ng Designated Posi�ons (TDPs):

Yes No Don't Know

9. Source for Tes�ng Designated Posi�ons informa�on provided above1:

1 Informa�on/data sources should be internal agency or Department sources used to provide the informa�on/data for the survey ques�on, such as data sources or internal agency data systems.

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Employee Assistance Program

10. Indicate the services your agency Employee Assistance Program (EAP) offers2: (Check all that apply)

Educa�on

Counseling

Referral to Rehabilita�on

Coordina�on with Available Community Resources

Assessment

Monitoring Employee Progress

Other

2 Components noted above are components noted in the Model Plan for a Comprehensive Drug-Free Workplace Program.

11. Is your agency's Employee Assistance Program:

In-house

Contractor-operated

12. Source for Employee Assistance Program informa�on provided above3:

3 Informa�on/data sources should be internal agency or Department sources used to provide the informa�on/data for the survey ques�on, such as data sources or internal agency data systems.

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Supervisor Training

13. How is your agency’s drug-free workplace supervisor training delivered to supervisors? (Check all that apply)

Periodic, regularly scheduled training

Special classroom course

Online course

14. Which of the following components/topics are included in your supervisor training program4? (Check all that apply)

Overall agency policy

Prevalence of various employee drug problems

EAP approach to handling problems, including the supervisor's role and rela�onship to EAP

Recognizing employees with possible problems

Documen�ng employee performance or behavior

Skills in confron�ng employees with possible problems

Agency procedures for EAP referrals

Disciplinary ac�on and removals from sensi�ve posi�ons

Reintegra�on of employees into the workforce

Wri�en materials the supervisor can use at the work site

4 Components noted above are components noted in the Model Plan for a Comprehensive Drug-Free Workplace Program.

15. During this repor�ng period, was the supervisor training program reviewed?

Yes No

16. During this repor�ng period, was the supervisor training program updated?

Yes No

17. During this repor�ng period, was supervisor training delivered?

Yes No

18. Source for Supervisor Training informa�on provided above5:

5 Informa�on/data sources should be internal agency or Department sources used to provide the informa�on/data for the survey ques�on, such as data sources or internal agency data systems.

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Employee Education

NOTE: ‘Employees’ in this sec�on refers to all employees, including supervisors.

19. How is your agency’s drug-free workplace employee educa�on delivered to employees? (Check all that apply)

Distribu�on of wri�en material

Audio or video programs

Group discussions and presenta�ons

Special drug awareness promo�ons

20. Which of the following components/topics are included in employee educa�on6? (Check all that apply)

Agency's substance abuse policy, procedures, and program

Types and effects of drugs

Symptoms of drug use and the effects on performance and conduct

EAP

Relevant treatment, rehabilita�on, confiden�ality issues

6 Components noted above are components noted in the Model Plan for a Comprehensive Drug-Free Workplace Program.

21. During this repor�ng period, was employee educa�on reviewed?

Yes No

22. During this repor�ng period, was employee educa�on updated?

Yes No

23. During this repor�ng period, was employee educa�on delivered?

Yes No

24. Source for Employee Educa�on informa�on provided above7:

7 Informa�on/data sources should be internal agency or Department sources used to provide the informa�on/data for the survey ques�on, such as data sources or internal agency data systems.

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Drug Testing

25. Indicate the drugs for which your agency's employees are tested:

Cocaine and Marijuana only (noted in Mandatory Guidelines for Federal Workplace Drug Tes�ng Programs)

Standard Panel (Cocaine, Marijuana, Amphetamines, Opiates, and PCP)

Standard Panel and Semi-Synthe�c Opioids (Cocaine, Marijuana, Amphetamines, Opiates, PCP, and Semi-Synthe�c Opioids Oxycodone, Oxymorphone, Hydrocodone, Hydromorphone)

26. What organiza�ons provide your agency’s drug tes�ng services? (If informa�on for a Third-Party Administrator is entered, Collec�on, Laboratory, MRO, and Blind Quality Control fields should be le� blank)

Collec�on

Laboratory

Medical Review Officer

(MRO)

Blind Quality Control

OR

Third Party Administrator (TPA) for all services

27. For this repor�ng period, please fill in the numerical values for your agency:

Data Requested Number

Total Number of Full-Time Equivalents (FTEs8) - including vacant FTEs

Total Number of FTEs in Tes�ng Designated Posi�ons (TDPs9)

- including vacant TDPs (i.e., in the Random Drug Tes�ng Pool)

Percent of FTEs in Tes�ng Designated Posi�ons (TDPs10)

TDP Random Tes�ng Rate According to your Most Recent Plan Date of most recent DFWP plan

Percent of TDPs Tested (actual TDP random tes�ng rate11) 8 FTEs are federal civilian Full-Time Equivalents.

9 This ques�on asks for the total number of FTEs in TDPs.

10 Auto-calculated: Total Number of FTEs in Tes�ng Designated Posi�ons divided by Total Number of FTEs.

11 Auto-calculated: Total Persons Tested (Random Selec�on Q28a) divided by Total Number of FTEs in Tes�ng Designated Posi�ons.

28. Tes�ng Results by Circumstance and Drug in FY 2021

NOTE: An individual may be tested under more than one circumstance in the repor�ng period and if so each test is counted separately Any single test may be

0.0 %

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NOTE: An individual may be tested under more than one circumstance in the repor�ng period, and, if so, each test is counted separately. Any single test may be reported posi�ve for more than one drug and, if so, each result for each drug tested is also counted separately.

28a. Tes�ng Results by Person

Tes�ng Results

Tes�ng Circumstances and Number of Tests by Person

Reasonable Suspicion

Accident or Unsafe Prac�ce

Random Selec�on Volunteer Follow-up Applicant Total Tests12

Total Persons Tested13

Total Test Refusals

Total Persons Verified Posi�ve14

Drug Tes�ng Posi�vity Rate15

12 Auto-calculated: sum of columns to le�.

13 Total tests administered at the person level. Note: Individuals can be tested more than once. If a person is tested more than one �me, each test should be counted.

14 Total tests verified posi�ve (at the person-level, posi�ve for one or more drugs). Verified posi�ve test results are reported by the MRO.

15 Drug Tes�ng Posi�vity Rate= Sum of total persons verified posi�ve divided by sum of total persons tested.

28b. Tes�ng Results by Tes�ng Circumstance (NOTE: Fields containing "0" will auto-populate and or sum as numbers are entered)

Tes�ng Results by Drug

Tes�ng Circumstances and Number of Tests by Drug Test Type

Reasonable Suspicion

Accident or Unsafe Prac�ce

Random Selec�on Volunteer Follow-up Applicant Total Tests16

A. Total Non-Nega�ve Test Results17

B. Total Verified Posi�ve Test Results18

1. For Cocaine

2. For Marijuana

3. For Amphetamines/ Methamphetamines19

3a: Amphetamine

3b: MDMA

3c: MDA

3d: Unspecified

4. For Opiates20

4a: Codeine

4b: Morphine

4c: 6 AM

4d: Unspecified

5. For Semi-Synthe�c Opioids21

5a: Hydrocodone

5b: Hydromorphone

5c: Oxycodone

5d: Oxymorphone

5e: Unspecified

6. For PCP

C. Total Adulterated Specimens

D. Total Subs�tuted Specimens

E. Total Invalid Specimens 16 Auto-calculated: sum of columns to le�.

17 Auto-calculated; A=sum of (B, C, D, E).

18 Auto-calculated; B=sum of (1, 2, 3, 4, 5, 6).

19 Auto-calculated; 3=sum of (3a, 3b, 3c, 3d).

20 Auto-calculated; 4=sum of (4a, 4b, 4c, 4d).

21 Auto-calculated; 5=sum of (5a, 5b, 5c, 5d, 5e).

29. Source for Drug Tes�ng informa�on provided above22:

22 Informa�on/data sources should be internal agency or Department sources used to provide the informa�on/data for the survey ques�on, such as data sources or internal agency data systems.

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0.0 %

0 0 0 0 0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0

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Follow-up Actions NOTE: Ac�ons reported here may pertain to employees whose tests were reported in a prior repor�ng period. There may be more than one ac�on reported for an employee.

30. Non-Disciplinary and Disciplinary Ac�ons Proposed/Ac�ons Taken

Total Follow-up Ac�ons

Non-Disciplinary Ac�ons Number of Ac�ons Taken Addi�onal Comments

Referred to EAP

Required Return to Work Following Test

Detailed from TDP to Non-Sensi�ve Posi�on

Permanent Reassignment

Re�rement

Resigna�on

Other

TOTAL

Disciplinary Ac�ons Number of

Ac�ons Proposed

Number of Ac�ons Taken

Addi�onal Comments

Wri�en Reprimand

Temporary Suspension

Indefinite Suspension

Demo�on

Termina�on: Removal/Separa�on/Dismissal

Enforced Leave (Mandatory Leave)

Other

TOTAL

31. Reasons for Disciplinary Ac�on by Type of Ac�on

Reason

Number of Removals/

Separa�ons/ Dismissals

Number of Other Ac�ons Addi�onal Comments

Possession of drug/Selling at work

Convic�on for a drug offense

Direct observa�on of drug use

R f i i l i

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Refusing urinalysis

Specimen tampering

Tested posi�ve for drug use: 1st finding

Tested posi�ve for drug use: 2nd finding

Refusal to cooperate

Failure to successfully complete EAP

Failure to successfully complete recommended counseling/treatment

Other reasons

TOTAL

32. Source for Follow-up Ac�ons informa�on provided above23:

23 Informa�on/data sources should be internal agency or Department sources used to provide the informa�on/data for the survey ques�on, such as data sources or internal agency data systems.

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Page 9 of 10 Follow-up Ac�ons

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