5-Drug Free Workplace Form.pdf
PDF 92 KB Posted
- Solicitation number
- ITB No. 2026-024
- 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 contractors bidding on the A39, A42, A43 Pump Station Ventilation Improvements project. The certification mandates that bidders establish and maintain a drug-free workplace by publishing a statement prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances; establishing a drug-free awareness program informing employees of abuse dangers, company policy, available counseling and rehabilitation programs, and penalties for violations; providing all employees engaged in grant performance with a copy of the workplace prohibition statement; and requiring employees to notify their employer of any criminal drug statute convictions occurring in the workplace within five days. The Town must be notified within ten days of receiving notice of employee convictions, and the contractor must take appropriate personnel action, up to and including termination, or require the convicted employee to participate in an approved drug abuse assistance or rehabilitation program within thirty days of receiving notice.
The certification requires the authorized agent of the firm to sign and date the form, certifying full compliance with all seven enumerated drug-free workplace requirements. The form includes fields for firm name, authorized agent name and title, email, phone number, and signature or eSignature. This certification is a mandatory prerequisite for bid submission on the Town of Palm Beach wastewater pump station ventilation project and reflects federal grant compliance requirements applicable to public works contracts.
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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 .