Laserfiche WebLink
©National Compliance Management Service (NCMS): NCMS Model - Revised June 2021 16 <br />ATTACHMENT 3 <br />SUPERVISOR DRUG AND/OR ALCOHOL CHECKLIST <br />Supervisor Drug and/or Alcohol Checklist <br />Question Yes No <br />1.Smell of alcohol on breath of person? <br />2.Speech: <br />•Slurred? <br />•Confused? <br />•Fragmented? <br />•Slow? <br />•Unusually soft? <br />•Unusually loud? <br />3.Disorientation – Is the contractor confused about: <br />•Where he or she is? <br />•What day it is? <br />•What time it is? <br />4.Apparent inability to focus on work? <br />5.Unusual or unexplained resistance to authority or refusal to follow reasonable directions? <br />6.Lack of motor coordination? <br />7.Mood: <br />•Belligerent? <br />•Moody? <br />•Ecstatic? <br />•More nervous than usual? <br />•Giddy? <br />•Talkative? <br />•Drowsy? <br />8.Skin color: <br />•Pale? <br />•Flushed? <br />9.Excessive perspiration? <br />10.Excessive trips to the restroom? <br />11.Bloodshot eyes? <br />12.Dilated pupils? <br />13.Pinpoint pupils? <br />14.Traces of alcohol in containers? <br />15.Confession by contractor that he/she was drinking alcohol or ingesting drugs? <br />16.Confirmation by other contractors or employees? <br />17.Presence of substances with the appearance of drugs? <br />18.Presence of drug paraphernalia? <br />19.Smell of marijuana? <br />20.Congregation of contractors in remote areas of the companies, facilities, or in areas not <br />usually frequented by contractors? <br />21.Weariness, fatigue, or exhaustion? <br />22.Deteriorating physical appearance? <br />23.Yawning excessively?