5-Drug Free Workplace Form.pdf
PDF 92 KB Posted
- Attached to
- Par 3 Restroom Renovation
- Solicitation number
- ITB No. 2026-025
- 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 Par 3 Restroom Renovation project. The certification establishes mandatory drug-free workplace requirements that selected contractors must comply with throughout the contract period. The contractor must publish a statement prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances in the workplace and establish a drug-free awareness program informing employees about the dangers of drug abuse, the grantee's drug-free workplace policy, available counseling and rehabilitation programs, and penalties for violations. Each employee engaged in the grant performance must receive a copy of the prohibition statement and be notified that compliance is a condition of employment, including an obligation to report any criminal drug statute conviction occurring in the workplace within five days of conviction. The grantee must notify the Town within ten days of receiving notice of employee convictions and take appropriate personnel action, up to and including termination, or require the employee to participate in an approved drug abuse assistance or rehabilitation program within thirty days of receiving notice.
The authorized representative of the contractor must certify compliance with all seven enumerated drug-free workplace requirements by signing and dating the form, providing the firm name, authorized agent name and title, email address, phone number, and signature. This certification demonstrates the contractor's commitment to maintaining a drug-free workplace throughout the project period and is a mandatory compliance document for bid submission and contract award for the Par 3 Golf Course Old Clubhouse restroom renovation project.
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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 .