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16. Confirmation by other 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 employees in remote areas of the company's facilities or in areas not <br />usually frequented by employees? <br />21. Weariness, fatigue, or exhaustion? <br />22. Deteriorating physical appearance? <br />E. PHYSICAL INDICATORS (Con't) <br />YES NO <br />23. <br />Yawning excessively? <br />24, <br />Blank stare or expression? <br />25. <br />Sudden and/or unpredictable change in energy level? <br />26. <br />Unusually energetic? <br />27. <br />Shaking or trembling of hands? <br />28. <br />Sunglasses worn at inappropriate times? <br />_ 29. <br />Changes in appearance after lunch break? <br />_ 30, <br />Breathing or swallowing difficulties? <br />31. <br />Unusual sneezing/nasal congestion? <br />_ 32. <br />Needle marks on arms? <br />33. <br />Prolonged lunch hours? <br />34. <br />Tardiness? <br />Other information/observations - (Please be specific &attach additional sheet as <br />SUPERVISOR #1 (print name) <br />SUPERVISOR 81 (signature/date) <br />SUPERVISOR #2 (print name) <br />eeded). <br />SUPERVISOR #2 (signature/date) <br />Premium Concrete Services, Inc.- PHMSA DRUG/ALCOHOL PLAN <br />C) NATIONAL COMPLIANCE MANAGEMENT SENVICE, INC (NCMS12011 iuptlate 2021). Tlie NCMS plan Is <br />the subject era registered wpYright and Is protected by copyright laws In the U.S. and elsewhere. All rlgiils <br />esewed <br />Ei': <br />