Application For Certification Of Drug-Free Workplace Premium Credit Program (Page 4 of 5) in pdf

Application For Certification Of Drug-Free Workplace Premium Credit Program Page 4

_____

Collection of job applicant and employee specimens is performed in accordance with

the standards and procedures outlined in the guidelines for certification.



Employer Responsibilities Required for Certification:

(Code of Alabama, 1975, §25-5-335 (c)(6) through (12))

_____

The employer is complying with the procedures that are outlined in the guidelines for

certification.



Laboratory Responsibilities Required for Certification:

(Code of Alabama, 1975, §25-5-335 (d)(1) through (3))

_____

The laboratory that the employer is using is complying with the procedures that are

outlined in the guidelines for certification.

Name and address of laboratory: ___________________________________________________

______________________________________________________________________________

Phone Number: ( _ )________________________________

Certification of laboratory NIDA___________CAP__________

Employee Assistance Required for Certification:

(Code of Alabama, 1975, §25-5-336)

_____

EITHER you have an employee assistance program (EAP)

OR you maintain and post other means of employee assistance

Employee Education Required for Certification:

(Code of Alabama, 1975, §25-5-337 (a))

_____

Hour One of the Employee Education program has been conducted for employees.

(Date of Program _______________)

_____

Hour Two of the Employee Education program has been conducted for employees.

(Date of Program _______________)

Application For Certification Of Drug-Free Workplace Premium Credit Program Page 4