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10. <br />11. <br />_ 12. <br />Major change in duties or responsibilities <br />Interferes with or ignores established procedures <br />Inability to follow through on job performance recommendation <br />D. PERSONAL MATTERS <br />YES NO <br />1. <br />Changes in or unusual personal appearance (dress, hygiene) <br />2. <br />Changes in or unusual speech (incoherent, stuttering, loud) <br />_ _ 3. <br />Changes in or unusual physical mannerisms (gesture, posture) <br />4. <br />Changes in or unusual facial expressions <br />5. <br />Changes in or unusual level of activity -much reduced/increased <br />6. <br />Changes in or unusual topics of conversation <br />_ _ <br />7. <br />Engages in detailed discussions about death, suicide, harming others <br />_ _ <br />_ _ 8. <br />Increasingly irritable or tearful <br />9. <br />Persistently boisterous or rambunctious <br />_ _ <br />10. <br />Unpredictable or out -of -context displays of emotion <br />11. <br />Unusual fears or lacks appropriate caution. <br />_ _ <br />12, <br />Engages in detailed discussion about obtaining/using drugs/alcohol <br />_ _ <br />13. <br />Has personal relationship problems (spouse, girl/boyfriend, children,. in-laws) <br />_ _ <br />14. <br />Has received professional assistance for emotional or physical problems <br />_ _ <br />15, <br />Makes unfounded accusations toward others, i.e., has feelings of persecution <br />_ 16. <br />Secretive or furtive <br />17. <br />Memory problems (difficulty recalling instructions, data, past behaviors) <br />18. <br />Frequent colds, flu, excessive fatigue, or other illnesses <br />19. <br />Makes unreliable or false statements <br />_ <br />20, <br />Unrealistic self -appraisal or grandiose statements <br />_ 21. <br />Temper tantrums or angry outbursts <br />22. <br />Demanding, rigid, inflexible <br />23. <br />Major change in physical health <br />24. <br />Concerns about sexual behavior or sexual harassment <br />E. PHYSICAL INDICATORS <br />YES NO <br />1. Smell of alcohol on breath or person? <br />2. Speech: Slurred? <br />Confused? <br />Fragmented? _ <br />Slow? <br />Unusually soft? _ <br />Unusually loud? _ <br />_ 3. Disorientation: Is employee 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: Belligerent? _ <br />Moody? <br />Ecstatic? _ <br />More nervous than usual? _ <br />Giddy? _ <br />Talkative? _ <br />Drowsy? <br />8. Skin color: 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 employee that he/she was drinking alcohol or ingesting drugs? <br />Premium Concrete Services, Inc.- PHMSA DRUG/ALCOHOL PLAN <br />0 NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCMS) 2011 (updale 2021) The NCMS plan Is <br />the subject of a registered Copyright end Is protected by copyright laws In the U S. and elsewhere All rights <br />reserved <br />58 <br />