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16. <br />Confirmation by other employees? <br />_ 17, <br />Presence of substances with the appearance of drugs? <br />18. <br />Presence of drug paraphernalia? <br />19. <br />Smell of marijuana? <br />_ 20, <br />Congregation of employees in remote areas of the company's facilities or in areas not <br />usually frequented by employees? <br />21. <br />Weariness, fatigue, or exhaustion? <br />_ 22. <br />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 informatiomobservations - (Please be specific & attach additional sheet as needed). <br />SUPERVISOR 41 (print <br />name) SUPERVISOR #2 (print name) <br />SUPERVISOR #1 (signature/date) SUPERVISOR #2 (signature/date) <br />Premium Concrete Services, Inc.- PHMSA DRUG/ALCOHOL PLAN <br />C."� NATIONAL COMPLIANCE M�NAOEMENT SERVICr. INC. (NCM5) �0� i (update 2021). Tha NCMS plan Is <br />ihe,subfecl of e reylsteeetl wpy�ight anA is protected by moyngh� le�vs in Ilse U.S. and elso�vhere. NI riglils <br />eserved <br />59 <br />