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<br />fIVILDING ANI)QINM'RUCJ'Jf)N L1LS.0k4b(T.(XNr1'FI1, INC.`.
<br />61,11' Ar O� " �C'TQ R ��; 17:cal 1
<br />JMY . - _Jk)N
<br />ANALV5'1S A_NQ AJ1J'JJ!QRIZAJ'JQN FORRELEASLOF RESUI
<br />1, one undersigned, ....... . , 11 do hereby authorize the testing of my body fluids
<br />for employment reasons and understand and agree that the results of'arry, such feeling will be turned
<br />over to the Building and Constructions Resource Center, Inc..and, further that the training procedures
<br />will be limited to tests for prohibited and illegal drugs and controlled substances
<br />I understand that the results of these tests may be used for employment and disciplinary reasons and
<br />hereby authorise the release of such information from the laboratory and MRO
<br />I further county that the came specimen collecked from me is mine and no adulterated or altered in
<br />any mariner. I have been advised that matters appealing me relative to the interpretation or
<br />application of one Drug policy and subject exclusively to the grievance and arbitration procedure
<br />under my collective bargaining agreement (if applicable).
<br />Attachment F
<br />Signature ofAliplicano/Employee
<br />Dire " --' . ... .. . .......... .... . Ranploye's Social I Security Number
<br />Time Employee's Telephone rminbe,
<br />FmpJ.y,=',, Addncs
<br />Suack iqs Co'do............
<br />...............
<br />M
<br />Drug and Alcohol Policy
<br />in complianceivof,rh
<br />49 ( 'hl? Part 40, and
<br />49 CPR Par? 382 (FMCSA)
<br />for
<br />DOT -Covered Contractor Participants
<br />BCRC Baud Approved August 18,2004
<br />BUILDING and CONSTRUCTION RESOURCE CENTER
<br />(BCRC)
<br />Drug and Alcohol Policy
<br />in compliance with
<br />49 CFR Part 40, and
<br />49 CFR Part 382 (FMCSA)
<br />for
<br />DOT -Covered Contractor Participants
<br />BCRC Baud Approved August 18,2004
<br />L PURPOSE
<br />Building and Construction R ....... " Card. ("BCRC", "the Assochalon") has established
<br />this alcohol and controlled substances testing program for contractor participants who
<br />have employees that are drivers of Commercial Motor Vehicles (CMVs) and nloo require
<br />Commercial Drivers Licenses (CDLs), to meet requirements of the U.S. Department of
<br />Transportation(DOT) The overall goods of this testing program are to ensure a safe and
<br />drug -Free transportation environment, to reduce the potential for accidents and casualties
<br />related to accidents involving Company -owned /-leased vehicles, and to cooperate with
<br />the U.S. Department of Transportation and the transportation industry in efforts to
<br />eliminate the unsure of alcohol and the illegal use ofcontrolled substances by our
<br />drivers
<br />With these objectives in mind, BCRC has established the following policy and
<br />procedures for DOT -covered employees of its contractor participants Full compliance
<br />with this policy is a condition of employment wild; each individual contractor.
<br />11. SCOPE
<br />BCRC's Drug and Alcohol Policy for DOT- Covered Employees, outlined below, applies
<br />to all full-time, part-time, and temporary employees who are "covered drivers" as dell-cl
<br />inSection VIIA) This policy also covers independent drivers %%,he may be specifically
<br />named in a contract to provide service In addition, this policy covers all job applicants
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<br />INFORMATION AND INSTRUCTION SHEET
<br />BCRC is exercising extreme cue to ensure that sami, quality control measures are followed in
<br />the collection, mapping, and analysis of you specimen You pho, an important role in [his
<br />process and should be contain [hat you have provided an unadulterated specimen to the
<br />laboratory Remember, you are certifying that the specimen mhichyou provide is ycim; and is
<br />unadulterated. Any adulteration or switching of specimen is a breach ofBCRC's rules and, if
<br />you are employed, may subject you to discipline up to and including termination by you
<br />employer
<br />Forvour own protection and Mee of mind, we ask that you:
<br />Provide a picture idemi fication to his colleefionsitic/lechnician at time of moral;
<br />Be escorted to a collection room and asked to provide an unadulterated specimen no
<br />the collection bottle provided The bottle should be filled to 60ml;
<br />Return the specimen bodie to the medical technician and witness, initial and dale the
<br />integrity cards placed on your specimen;
<br />men:
<br />Verify the proper spelling of) our time as recorded on the log sheet;
<br />Verily that 3 our social scrum) number has been properlYuscorded:
<br />Verip, that the social security number placed on your specimen bottle is the same Is
<br />that recorded on the log sheet and the Chain of Custody room
<br />I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY TO ASK
<br />QUESTIONS REGARDING THIS PROCEDURE.
<br />BCRC Applicant/Cardholder Signinurit I Law
<br />34
<br />for positions that require Commercial Drivers Licenses (CDL) for the operating of
<br />Commercial Minor Vehicles as described in Section VI [A)
<br />In those circumstances that are not addressed by DOTregalwairis or in this policy, DOT -
<br />covered employees contain subject to onfles, and testing as defined in BCRC'v Drug and
<br />Alcohol Policy for all employees
<br />In addition, a driver will be required to submit to a non -DOT test for reasonable suspicion
<br />in those circumstances when the driver is suspected of drug or alcohol use, or has
<br />violated a work infle as stated elsewhere in this policy, or is involved in or may have
<br />contributed to the cawing of m accident, or causes injury to hanuberself or to another
<br />person, when the circumstances related to that incident do not main the requirements of
<br />DOT test
<br />11L REFERENCES
<br />Title 49 CFR §382, in al, fto�-
<br />Title 49 CFR §40, AWBJqjigI ],,u�.Wjog
<br />pawala
<br />Title 41 U.S.C. §§ 403, 701 at Sea ,
<br />Note: If there are conflicts between federal regulations and this policy, aldribuledin part
<br />to revisions to the law or changes in interpretations, and when those changes have not
<br />been updated or accurately repeated in this policy, the Federal law shall prevail
<br />IV. POLICY / RULES OF CONDUCT
<br />A driver who violates the FMCSA prohibitions of this policy (Section VII Bk, including a
<br />refusal no he tested, mod be immediately removed from all FMCSA rarely-sensilive
<br />functions, including driving, in accordance with 49 CFR Part 382 501, FMCSA rates and
<br />ieguhifi... Law, each employer's independent authority, the drive, will be subject to
<br />disciplinary action up to and including termination ofemploymenI
<br />An employer also reserves the fight to take action against an employee, where
<br />appropriate, for violation brother general employer policies, procedures anchor rules that
<br />may be defined in nuns that are separate from this policy for DOT -covered employees
<br />A A covered driver may not engage in any of the conducts) prohibited in Section
<br />VI[B]
<br />B Under independent authority, BCRC prohibits the possession of alcohol, or the
<br />sale, purchase, manufacture, possession or transfer of an illegal drug, or being
<br />under the influence of alcohol or of an illegal drug, during all work time,
<br />including meals and breaks, or at my time while on Company property, at a
<br />Company',, job site, shippeh/vactdver site, track stop, rest itica, on Company
<br />business, or in a Company -owned Meased vehicle An employee who possesses
<br />alcohol, or who uses alcohol while on duly, will be terminated from employment
<br />C Under independent authority, BCRC prohibits the use of any over-the-counter
<br />medication by an employee during working time or any time while on Company
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