7._Drug-free_Workplace_Form.pdf
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- Solicitation number
- RFP 18-820-26 Division of Water Tongass Narrows Sampling
- Issued by
- Ketchikan Gateway Borough, Alaska
About this file
This is a Drug-Free Workplace Certification form required by 28 CFR Part 67, applicable to the State of Alaska, Department of Environmental Conservation (DEC), Division of Water for the Tongass Narrows water-quality sampling project (RFP 18-820-26). The certification establishes requirements for grantees and contractors to maintain drug-free workplace standards. The contractor must publish a statement prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances in the workplace and specifying disciplinary actions for violations. An ongoing drug-free awareness program must be established to inform employees about the dangers of drug abuse, the grantee's drug-free workplace policy, available counseling and rehabilitation resources, and penalties for violations. Each employee engaged in grant performance must receive a copy of the workplace statement and be notified that compliance is a condition of employment. Employees are required to notify their employer in writing of any criminal drug statute convictions occurring in the workplace within five calendar days of conviction.
The employer must notify the contracting agency in writing within ten calendar days of receiving notice of employee conviction, including the employee's position title and affected grant identification numbers. Within thirty calendar days of receiving conviction notice, the employer must take appropriate personnel action, up to and including termination consistent with the Rehabilitation Act of 1973, or require the employee to participate in a Federal, State, or local approved drug abuse assistance or rehabilitation program. The employer must make a good faith effort to maintain a drug-free workplace through implementation of all specified requirements. The form requires identification of the place of performance by street address, city, county, state, and postal code, and must be completed and signed by an authorized representative with the date of certification.
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Text version
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
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