Drug Free Affidavit.pdf

This document consists of two forms from the State of West Virginia Purchasing Division establishing compliance requirements for drug-free workplace certification on state and local contracts. The first form, WV-72 (Certified Drug-Free Workplace Report Coversheet), is a reporting template revised August 1, 2015, that contractors must complete and submit annually or upon project completion for contracts exceeding $25,000 to the West Virginia Purchasing Division at 2019 Washington Street East, Charleston, WV 25305. For contracts of $25,000 or less, vendors submit reports directly to the issuing public authority. The form requires contractors to identify the contract number, contract purpose, and requesting agency, and to verify completion of required report content including education and training service compliance with West Virginia Code § 21-1D-5, identification of the certified drug testing laboratory, average number of employees connected to the construction project, and detailed drug test results across four categories: pre-employment and new hires, reasonable suspicion, post-accident, and random testing with positive and negative test counts.

The second form, WV-73 (Drug Free Workplace Conformance Affidavit), approved April 30, 2020, is a notarized affidavit template in which an employee attests under penalty of perjury that their company maintains a written drug-free workplace policy compliant with West Virginia Code §21-1D. The affidavit requires the affiant's printed name, signature, title, company name, and date, and must be notarized with the notary public's seal, signature, and commission expiration date. These documents collectively enforce West Virginia's mandatory drug-free workplace requirements for state contracting, ensuring contractor compliance through annual reporting and sworn certification of workplace safety policies.