<p>HR0206 (01/08) Health and Human Services Enterprise</p><p>Notice of Alcohol and Controlled Substance Testing – CDL Drivers</p><p>To be completed by the employee and sent to the HHS human resources office.</p><p>Your position with the agency requires you to have a commercial driver's license. You will be directed to undergo alcohol and controlled substance testing as required by Federal Highway Administration regulations (49 CFR, Parts 40 and 382). Refusal to submit to the testing will result in dismissal action being taken against you.</p><p>In accordance with the regulations, you have a packet of educational material containing the following:  the name of the testing program coordinator who can answer questions about the educational materials;  sufficient information about the safety-sensitive functions performed by those drivers to make clear what period of the work day the driver is required to be in compliance with this policy;  specific information concerning driver conduct that is prohibited;  the circumstances under which a driver will be tested for alcohol and/or controlled substances;  the procedures that will be used to: o test for the presence of alcohol and controlled substances, o protect the driver and the integrity of the testing processes, o safeguard the validity of the test results, and o ensure that those results are attributed to the correct driver, including post-accident information, procedures, and instructions;  the requirement that a driver submit to alcohol and controlled substances tests;  an explanation of what constitutes a refusal to submit to alcohol and controlled substances tests;  the consequences for drivers who are found to have violated the prohibitions of this policy, including the removal of the driver from performing safety-sensitive functions;  the consequences for drivers found to have an alcohol concentration level of 0.02 or higher, but less than 0.04;  information concerning the effects of alcohol and controlled substances on an individual’s health, work, and personal life;  information about the signs and symptoms of an alcohol or controlled substances problem (the driver’s or a coworker’s);  information about the available methods of intervening when an alcohol or controlled substances problem is suspected, including confrontation, referral to the employee assistance program, and referral to management; and  information on the department’s policies with respect to the use of alcohol or controlled substances.</p><p>Please sign below certifying that you have been notified of the alcohol and controlled substance testing requirements and that you have received the educational material listed above.</p><p>Employee Printed Name Date Employee ID</p><p>Employee Signature Agency</p><p>Page 1 of 1</p>