Drug Free Policy Development Worksheet For Governmental Entities
You have downloaded a Worksheet in order for your entity to receive a proposal to develop an Alabama Drug-Free Workplace Policy. Please answer the following questions and email the completed worksheet back 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 privilege 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 to confirm the work requested prior to drafting your Alabama Drug-Free Workplace Policy. If you have questions you may call attorney Tommy Eden at (334) 205-222-8030.


These materials are for educational purposes only and are not intended as a substitute for the legal advice of an attorney knowledgeable of the issues covered as they relate to a user’s individual circumstances. The presenter makes no assurances regarding the accuracy or completeness of the above information.

"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
Name of the Entity as it should appear throughout the Policy & Forms: *
Your answer
Abbreviated Name of the Entity as it should appear throughout the Policy & Forms: *
(such as "Vestavia Hills" rather than "City of Vestavia Hills, Alabama")
Your answer
Type of Entity: *
(Examples -- City, County, Town, Municipality, Village, Township, District, Authority, Board, Department, Commission, Agency, Parrish, Council, School, School District)
Your answer
Mailing Address: *
(Include City, State & Zip)
Your answer
Phone number for the Entity: *
Your answer
Fax number for the Entity: *
Your answer
Name of the Entity's "Designated Employer Representative" (DER): *
(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)
Your answer
Title of the Entity's DER: *
Your answer
Entity's Alternate DER: *
Your answer
Name of the Entity's certified Medical Review Officer (MRO): *
(Licensed physician (MD or DO) 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)
Your answer
Entity's EAP Provider: *
(Provide all contact information)
Your answer
Do you have any DOT regulated covered employees? *
If yes, which DOT Agency?
Your answer
Name of the Entity's Safety-Sensitive Evaluator: *
(Person designated by the DER to perform an evaluation of employee job duties and responsibilities for all Entity employees to determine which classifications are to be designated as safety-sensitive in accordance with the Policy Statement definition. These designations will appear on the "Determination of Safety-Sensitive Positions" form in the Forms Toolkit and in the Policy Statement given to all employees)
Your answer
List of safety-sensitive positions: *
(Those employees who discharge duties fraught with risks of injury to others that even a momentary lapse of attention can have disastrous consequences. Factors which have been considered in determining whether a position is safety-sensitive include handling of potentially dangerous machinery, mostly unsupervised responsibility for children, & handling of hazardous substances in an environment where others could be injured. Positions which have been found to be safety-sensitive include firefighters, emergency medical technicians, law enforcement officials who carry firearms, fire & police dispatchers, 911 operators, heavy machinery operators, bus drivers, some (but not all) transportation workers, pipeline operators, gas meter repairmen, jail officers, & airline industry personnel. Some employees which come under federal laws and regulations, such as those under the Department of Transportation regulations, natural gas pipeline industry, & aviation, are determined to be safety-sensitive by those regulations & should appear in your list. Unless an employee comes under drug-testing regulations of some federal agency, each position, job classification or department, must be evaluated to determine whether the employee is safety-sensitive.)
Your answer
When do you plan to implement the program? *
(Date)
Your answer
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