FNS 730 USDA Certification Drug-Free Workplace.pdf

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Attached to
Preadmission Screening and Resident Reviews (PASRR) Level II Screens
Solicitation number
S-0627 DCTS-17
Issued by
Wisconsin

About this file

This is a USDA Form FNS-730 Drug-Free Workplace Certification document required for grantees receiving grants from the U.S. Department of Agriculture under the Drug-Free Workplace Act of 1988. The form applies to the Wisconsin Department of Health Services in connection with the Preadmission Screening and Resident Reviews (PASRR) Level II Screens contract opportunity. The certification requires grantee organizations to establish and maintain drug-free workplace policies and procedures, including publishing statements prohibiting unlawful controlled substance manufacture, distribution, dispensing, possession, or use; establishing ongoing drug-free awareness programs; ensuring all employees engaged in grant performance receive copies of the workplace policy; and maintaining records of workplace locations where grant work occurs. Grantees must notify employees that they must abide by the drug-free workplace terms and report any criminal drug statute convictions in the workplace within five calendar days of conviction.

The certification requires grantees to notify the granting agency in writing within ten calendar days of receiving notice of an employee conviction and must take appropriate personnel action against convicted employees within 30 calendar days, including termination or required participation in an approved drug abuse assistance or rehabilitation program, consistent with the Rehabilitation Act of 1973. The form serves as a material representation of fact upon which the agency relies when awarding grants, and knowingly rendering false certification or violating Drug-Free Workplace Act requirements may result in agency enforcement action. Workplaces must be identified by actual building address or categorical descriptions and any changes to identified workplaces must be reported to the agency during the grant performance period.

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Electronic Form Version Designed in Adobe 7.1 VersionFORM FNS-730 (12/01)

This certification is required by the regulations implementing Sections 5151-5160 of the Drug-Free Workplace Act of 1988 (Pub. L.

100-690, Title V, Subtitle D; 41 U.S.C. 701 et seq.), 7 CFR Part 3017, Subpart F, Section 3017.600, Purpose. The January 31, 1989, regulations were amended and published as Part II of the May 25, 1990 Federal Register (pages 21681-21691). Copies of the regulations may be obtained by contacting the Department of Agriculture agency offering the grant.

U.S. DEPARTMENT OF AGRICULTURE

CERTIFICATION REGARDING

DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)

ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS

(Before completing Certification, read instructions on page 2)

Alternative I A.

Organization Name

Name and Title of Authorized Representative

Signature

Award Number or Project Name

Date

The grantee certifies that it will or will continue to provide a drug-free workplace by:

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;

(a)

(b) Establishing an ongoing drug-free awareness program to inform employees about --

(1) The dangers of drug abuse in the workplace;

(2) The grantee's policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance programs; and

(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c) 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);

(d) Notifying the employee in the statement required by paragraph

(a) that, as a condition of employment under the grant, the employee will --

(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;

(1) Abide by the terms of the statement; and

Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (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 on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number

(s) of each affected grant;

(e)

(1) 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

Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted --

(f)

(2) 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;

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

(g)

The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:

B.

Place of Performance (Street address, city, county, state, zip code)

Check if there are workplaces on file that are not identified here.

SBU

FORM FNS-730 (12/01)

1. By signing and submitting this form, the grantee is providing the certification set out on page 1.

2. The certification set out on page 1 is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act.

3. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements.

4. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes place.

Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation, State employees in each local unemployment office, performers in concert halls or radio studios).

5. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the change(s), if it previously identified the workplaces in question (see paragraph three).

6. Definitions of terms in the Non-procurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this certification. Granters' attention is called, in particular, to the following definitions from these rules:

"Controlled" substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15);

"Conviction" means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes;

"Criminal drug statute" means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance;

"Employee" means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) all "direct charge" employees; (ii) all "indirect charge" employees unless their impact or involvement is insignificant to the performance of the grant; and (iii) temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee's payroll.

This definition does not include workers not on the payroll of the grantee (e.

g., volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee's payroll; or employees of sub-recipients or subcontractors in covered workplaces).

INSTRUCTIONS FOR CERTIFICATION

Electronic Form Version Designed in Adobe 7.1 Version

Electronic Form Version Designed in Adobe 7.1 Version

FORM FNS-730 (12/01)

This certification is required by the regulations implementing Sections 5151-5160 of the Drug-Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D; 41 U.S.C. 701 et seq.), 7 CFR Part 3017, Subpart F, Section 3017.600, Purpose. The January 31, 1989, regulations were amended and published as Part II of the May 25, 1990 Federal Register (pages 21681-21691). Copies of the regulations may be obtained by contacting the Department of Agriculture agency offering the grant.

U.S. DEPARTMENT OF AGRICULTURE

CERTIFICATION REGARDING

DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)

ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS

(Before completing Certification, read instructions on page 2) Alternative I A.

Organization Name Name and Title of Authorized Representative Signature Award Number or Project Name Date The grantee certifies that it will or will continue to provide a drug-free workplace by:

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;

(a) (b) Establishing an ongoing drug-free awareness program to inform employees about --

(1) The dangers of drug abuse in the workplace;

(2) The grantee's policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance programs; and

(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c) 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);

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will --

(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;

(1) Abide by the terms of the statement; and Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (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 on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant;

(e)

(1) 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 Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted -- (f)

(2) 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;

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

(g) The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:

B.

Place of Performance (Street address, city, county, state, zip code) Check if there are workplaces on file that are not identified here.

SBU

FORM FNS-730 (12/01)

1. By signing and submitting this form, the grantee is providing the certification set out on page 1.

2. The certification set out on page 1 is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act.

3. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements.

4. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes place.

Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation, State employees in each local unemployment office, performers in concert halls or radio studios).

5. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the change(s), if it previously identified the workplaces in question (see paragraph three).

6. Definitions of terms in the Non-procurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this certification. Granters' attention is called, in particular, to the following definitions from these rules:

"Controlled" substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15);

"Conviction" means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes;

"Criminal drug statute" means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance;

"Employee" means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) all "direct charge" employees; (ii) all "indirect charge" employees unless their impact or involvement is insignificant to the performance of the grant; and (iii) temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee's payroll.

This definition does not include workers not on the payroll of the grantee (e.

g., volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee's payroll; or employees of sub-recipients or subcontractors in covered workplaces).

INSTRUCTIONS FOR CERTIFICATION

Electronic Form Version Designed in Adobe 7.1 Version 8.0.1291.1.339988.308172

ENTER NAME AND ADDRESS OF PLACE OF PERFORMANCE:
ENTER NAME AND ADDRESS OF PLACE OF PERFORMANCE:
ENTER NAME AND ADDRESS OF PLACE OF PERFORMANCE:
ENTER ORGANIZATION NAME:
ENTER DATE:
ENTER AWARD NUMBER:
ENTER NAME AND TITLE OF REPRESENTATIVE:
PRINT FORM:
CHECK IF THERE ARE OTHER WORKPLACES: 0

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