6._Drug-free_Workplace_Form.pdf

28 CFR Part 67 – Certification Regarding Drug-Free Workplace Requirements

This certification is required by the regulations that the grantee certifies that it will or will continue to 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 an ongoing 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 (a);

4) Notifying the employee in the statement required by paragraph (a) 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 in writing of their conviction for a violation of a criminal drug statute;

i) occurring in the workplace no later than five calendar days after such conviction;

5) Notifying the agency in writing within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working unless the Federal agency has designated a central point for receiving such notices. Notice shall include the identification number(s) of each affected grant;

6) Taking one of the following actions within 30 calendar days of receiving notice under paragraph (d)(2) concerning any employee who is so convicted;

7) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

8) Requiring such employees to participate satisfactorily in a drug abuse assistance or rehabilitation program;

a) approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

9) Making a good faith effort to continue to maintain a drug-free workplace through the implementation of paragraphs (a), (b), (c), (d), (e), and (f).

PLACE OF PERFORMANCE (STREET ADDRESS, CITY, COUNTY, STATE, AND POSTAL CODE)

☐ CHECK IF THERE ARE WORKPLACES ON FILE THAT ARE NOT IDENTIFIED HERE.

PRINT NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE DATE

28 CFR Part 67 – Certification Regarding Drug-Free Workplace Requirements