5-Drug Free Workplace Form.pdf
PDF 92 KB Posted
- Attached to
- Pinewalk Transfer Station Repairs
- Solicitation number
- ITB No. 2026-012
- Issued by
- Palm Beach County, Florida
About this file
This is a Drug-Free Workplace Certification form required by the Town of Palm Beach, Florida for the Pinewalk Transfer Station Repairs project. The certification establishes mandatory drug-free workplace requirements that contractors must implement and maintain throughout contract performance. Bidders must acknowledge compliance with seven key requirements: publishing a workplace drug prohibition statement to all employees, establishing a drug-free awareness program addressing dangers of drug abuse and available assistance resources, distributing the prohibition statement to all grant-funded employees, requiring employees to notify the employer of any criminal drug convictions within five days, notifying the Town within ten days of receiving such notice, taking appropriate personnel action or requiring rehabilitation within thirty days of conviction notice, and maintaining good faith implementation of all requirements throughout the contract term.
The certification must be signed by an authorized agent of the bidding firm with the firm name, date, agent name and title, email, phone number, and signature. The form serves as a compliance document that demonstrates the contractor's commitment to maintaining a drug-free workplace and is a standard requirement for Town of Palm Beach contracts. No specific pricing, set-asides, or funding information is contained within this certification document, as it functions solely as a prerequisite compliance declaration rather than a substantive contract terms document.
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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 .