7-TOPB Drug Free Workplace Form.pdf
PDF 90 KB Posted
- Attached to
- Prequalification of Roofing Contractors
- Solicitation number
- RFQ No. 2025-029
- Issued by
- Palm Beach County, Florida
About this file
This is a Drug Free Workplace Certification form from the Town of Palm Beach that contractors and grantees must complete to certify compliance with federal drug-free workplace requirements. The form requires the signing entity to commit to maintaining a drug-free workplace through seven specific requirements: publishing a statement prohibiting controlled substances in the workplace, establishing a drug-free awareness program, providing copies of the policy to all employees working on the grant, notifying employees of their obligations including reporting criminal drug convictions within five days, notifying the agency within ten days of receiving notice of employee convictions, taking appropriate personnel action against convicted employees within 30 days (including termination or requiring participation in rehabilitation programs), and making good faith efforts to maintain ongoing compliance.
The certification form includes signature fields for the firm name, date, authorized agent name and title, email, phone number, and signature. The document serves as a contractual commitment that the signing organization will implement and maintain all required drug-free workplace policies and procedures as a condition of receiving grant funding or contracting with the Town of Palm Beach. No specific pricing, contract terms, or funding amounts are referenced in this standardized certification document.
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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:
File details come from the government source that posted it. Updated .