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ACKNOWLEDGMENT OF RECEIPT AND REVIEW <br />OF VISU.SEWER'S <br />CONTROLLED SUBSTANCES/ALCOHOL POLICY <br />I acknowledge that I have received Visu-Sewer's Controlled Substances/Alcohol Policy. The Policy has <br />been reviewed with me and I am familiar with the information discussed during the review. I understand <br />that the Policy relates to my safety and terms of employment at Visu-Sewer. I agree to read the policy <br />and to ask any questions that I may have regarding the policy. <br />I have received training on the dangers of drug abuse in the workplace, the effects and consequences <br />of controlled substance use on personal health, safety and the work environment, and the manifestation <br />and behavioral changes that may indicate controlled substance use or abuse. <br />I further acknowledge that I have had an opportunity to ask any questions I have about the Policy and <br />related issues. I will direct any future questions regarding this Policy to Visu-Sewer's Safety Director. <br />Answers to my questions will be given to me by the Safety Director within 24 hours of my questions. <br />By my signature, I acknowledge the terms and conditions of the Policy and consent to testing as <br />described and required in the Detection Program. My signature certifies my commitment to assist Visu- <br />Sewer to enforce the Policy, my intent to comply with the Controlled Substances/Alcohol Policy and my <br />personal commitment to remain drug-free. <br />Employee's Printed Name <br />Employee's Signature <br />Management's Signature <br />APPENDIX D