Drug Free Policy Worksheet For Private Entities
 
You have downloaded a Worksheet in order for your entity to receive a proposal to develop a Drug-Free Workplace Policy.  Please answer the following questions and to have the completed worksheet sent to teden@constangy.com or bfrese@constangy.com. If you have a current policy, please email a copy of such in MS word format, if possible. No attorney-client relationship is formed solely based upon your submission of a completed worksheet or sending a copy of your current policy. You will be sent an engagement letter for signature to confirm the work requested prior to drafting your Drug-Free Workplace Policy.  If you have questions you may call attorney Tommy Eden at (334) 205-222-8030 or email to teden@constangy.com.

"No representation is made that the quality of legal services to be performed is greater than the quality of legal services performed by other lawyers."

Tommy Eden is an attorney with Constangy, Brooks & Smith, LLP, member of the ABA Section of Labor and Employment Law, East Alabama SHRM Board of Directors. Tommy can be contacted at teden@constangy.com or 334-246-2901 or his assistant Brad at bfrese@constangy.com or (334) 246-2902

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Name of the Entity as it should appear throughout the Policy & Forms: *
Abbreviated Name of the Entity as it should appear throughout the Policy & Forms (such as “ATC” rather than “American Trucking Company, Inc.”): *
Type of Entity:  (examples - Company, Organization, Agency, League, Association, Corporation, Firm, Group, Department, Practice, Partnership, Enterprise): *
Mailing Address (include city, state & zip code): *
Phone number: *
Fax number:
Title and/or Name of the Entity’s "Designated Employer Representative" – (This should be the person in charge of implementing the program, overseeing employee education, arranging for testing, and keeping records of the Entity’s compliance with drug-free workplace rules.  It is generally the personnel director, administrator, or your Entity’s equivalent): *
Back-up DER:
Name of your certified Medical Review Officer (MRO) – (a licensed physician (MD or DO) and who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results): *
EAP Provider (provide all contact information) *
If you have any DOT regulated covered employees, what DOT Agency covers you? *
When do you plan to implement the program (date)? *
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