Drug & Alcohol Discount - Annual Renewal
This program offers approved employers a ten percent (10%) discount off their base rate for the implementation of a drug free workplace program.

Please submit this application electronically ONLY IF YOU HAVE NO POLICY CHANGES.
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Email *
9 Digit Employer Number (Workers' Compensation Number) *
Employer/Business Name *
Drug-Free Workplace Coordinator Name *
Coordinator's Email *
Coordinator's Phone Number *
Employer/Business Address (include city, state and zip code) *
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