6-TOPB Drug Free Workplace Form.pdf
PDF 92 KB Posted
- Attached to
- RFQ No. 2026-013 Owner's Representative Services for Mid-Town Construction Projects State and local contract opportunity
- Solicitation number
- 2026-013
- 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 grant-funded contract opportunities. The certification establishes the Town's mandatory drug-free workplace policy for all vendors and their employees engaged in performance of grants. The form requires contractors to publish a statement prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances in the workplace; establish a drug-free awareness program informing employees of the dangers of drug abuse and available counseling resources; provide all employees with a copy of the drug-free workplace statement; and notify employees that compliance is a condition of employment under the grant. The contractor must require employees to report any criminal drug statute convictions occurring in the workplace within five days of conviction and notify the Town within ten days of receiving such notice.
The form obligates the contractor to take appropriate personnel action, up to and including termination, or require participation in an approved drug abuse assistance or rehabilitation program within thirty days of receiving notice of an employee conviction. The contractor must make a good faith effort to maintain a drug-free workplace through continuous implementation of these requirements. The authorized agent of the firm must sign and date the certification, providing contact information including title, email, and phone number. This certification applies to RFQ No. 2026-013 for Owner's Representative Services for Mid-Town Construction Projects, which includes potential services for the Mid-Town Seawall Replacement, Mid-Town Linear Park construction, Mid-Town Bathroom Renovation, and Mid-Town Paving and Infrastructure Improvements projects.
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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 .