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©National Compliance Management Service (NCMS): NCMS Model - Revised June 2021 17 <br />Supervisor Drug and/or Alcohol Checklist <br />Question Yes No <br />24.Blank stare or expression? <br />25.Sudden and/or unpredictable change in energy level? <br />26.Unusually energetic? <br />27.Shaking or trembling of hands? <br />28.Sunglasses worn at inappropriate times? <br />29.Changes in appearance after lunch break? <br />30.Withdrawal and avoidance of peers? <br />31.Complaints from co-workers? <br />32.Excessive absenteeism, especially Mondays, Fridays and days before or after holidays or <br />paydays? <br />33.Unusually high incidence of colds, flu, upset stomach, and/or headaches? <br />34.Unauthorized or unscheduled absences? <br />35.Breathing or swallowing difficulties? <br />36.Unusual sneezing / nasal congestion? <br />37.Needle marks on arms? <br />38.Prolonged lunch hours? <br />39.Tardiness? <br />40.Unexplained departures from work or disappearances from the job area? <br />41.More than average number of job-related mistakes injuries or accidents? <br />42.Decrease in efficiency or productivity? <br />43.Careless operation of equipment? <br />44.Careless performance of job?