Audubon Area Community Services, Inc.

Annual Employee Certification

I have read, understand and agree to comply with the following:

AACS, Inc. employees shall be advised of the following mandated legal requirements upon the agency and its employees pursuant to the Drug-Free Workplace Act of 1988. The Law (and the agency) requires:

• Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace...;

  [Refer to the AACS Personnel Manual/Appendix for the policy statement of personnel actions relating to an employee's violation of the above prohibitions and an inclusive listing of restricted substances.]

• Establishing a drug-free awareness program...;

• Making it a requirement that each employee engaged in the performance of a federal grant award be given a copy of the agency's drug-free workplace statement;

• Notifying the employee that he or she must abide by the terms of the agency's drug-free workplace policy and notify the employer of any drug statute conviction or violation occurring in the workplace no later than five (5) days after occurrence;

• Notifying the Federal sponsoring agency within ten (10) days after receiving any notice of any funded employee's actual conviction of a drug statute offense; and

• Certain actions, such as appropriate personnel action, up to and including termination, or forced or voluntary participation in a drug rehabilitation program, within thirty (30) days with respect to employees so convicted.

Staff must individually certify each year that they are aware of the requirements of and that they are in compliance with the provisions of the Drug-Free Workplace Act of 1988.

Any staffperson taking medications on the controlled substances list on order of their physician must report such prescribed use of these medications to the AACS, Inc. executive director prior to bringing such medications on AACS premises. In addition, employees should be aware that the use of such medications will be revealed through the required random drug testing, and only prior reported and verified physician-prescribed drug usage will be excused.

Staff must report any incidence of drug abuse, including alcohol, in AACS, Inc. offices, centers or facilities, whether involving staff, enrollees, volunteers, clientele or the public, to the AACS, Inc. executive director within five (5) calendar days.

I understand and shall comply in good faith with the above requirements.

Employee Signature : ______________________________________________________

One copy shall be retained by the employee; the duplicate shall be forwarded to the AACS Central Office for retention in the employee's Personnel File.