Va Form 10-0143 - Department Of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements For Grantees Other Than Individuals
Download a blank fillable Va Form 10-0143 - Department Of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements For Grantees Other Than Individuals in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Va Form 10-0143 - Department Of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements For Grantees Other Than Individuals with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB Number: 2900-0160
Estimated Burden: 5 minutes
DEPARTMENT OF VETERANS AFFAIRS CERTIFICATION REGARDING DRUG-FREE
WORKPLACE REQUIREMENTS FOR GRANTEES OTHER THAN INDIVIDUALS
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with
the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or
sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number.
We anticipate that the time expended by all individuals who must complete this form will average 5 minutes. This
includes the time it will take to read instructions, gather the necessary facts and fill out the form. Although this form
is required to obtain the grant, failure to furnish this information will have no impact on any other benefits to which
you may be entitled.
This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988, 38 CFR 44,
Subpart F. The regulations, published in the January 31, 1989, Federal Register (pages 4950-4952) require
certification by grantees, prior to award, that they will maintain a drug-free workplace. The certification set out
below is a material representation of fact upon which reliance will be placed when the agency determines to award the
grant. False certification or violation of the certification shall be grounds for suspension of payments, suspension or
termination of grants, or government-wide suspension or debarment (see CFR Part 44, Section 44.100 through
44.420).
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 such conviction;
(5) Notifying the agency within ten days after receiving notice under subparagraph (4) (b) from an employee or
otherwise receiving actual notice of such convictions;
(6) Taking one of the following actions, within 30 days of receiving notice under subparagraph (4) (b), with respect to
any employee who is so convicted;
(a) Taking appropriate personnel action against such 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) and (6).
VA FORM
10-0143
EXISTING STOCK OF VA FORM 10-0143, DATED SEP 1998, WILL BE USED.
SEP 2006 (R)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 40-0895-8 - Certification Regarding Drug-free Workplace Requirements For Grantees Other Than Individuals - Department Of Veterans Affairs
Legal
Va Form 10-0388-8 - Certification Regarding Drug-free Workplace Requirements For Grantees Other Than Individuals
Legal
Form 10-5368 - Department Of Veterans Affairs Research And Development Information System Investigator Data - State Of West Virginia
Legal
Form 10-2406 - Recommendation For Release Of Patient In Home Other Than Patient's Own - Department Of Veterans Affairs
Legal
Va Form 10-0094d - Dental Education Affiliation Agreement Between Department Of Veterans Affairs (va) And A School Of Dentistry As The Sponsoring Institution - 2015
Legal
Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And Institutions Sponsoring Graduate Medical Education And Their Affiliated School Of Medicine
Legal
Related Categories
Parent category: Legal