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10. Major change in duties or responsibilities <br />11. Interferes with or ignores established procedures <br />12. Inability to follow through on job performance recommendation <br />D. PERSONAL MATTERS <br />YES NO <br />1. Changes in or unusual personal appearance (dress, hygiene) <br />2. Changes in or unusual speech (incoherent, stuttering. loud) <br />3. Changes in or unusual physical mannerisms (gesture, posture) <br />4. Changes in or unusual facial expressions <br />5. Changes in or unusual level of activity -much reducedlincreased <br />6. Changes in or unusual topics of conversation <br />7. Engages in detailed discussions about death, suicide, harming others <br />8. Increasingly irritable or tearful <br />9. Persistently boisterous or rambunctious <br />10. Unpredictable or out -of -context displays of emotion <br />11. Unusual fears or lacks appropriate caution. <br />12. Engages in detailed discussion about obtaining/using drugs/alcohol <br />13. Has personal relationship problems (spouse, girl/boyfriend, children, in-laws) <br />14, Has received professional assistance for emotional or physical problems <br />15. Makes unfounded accusations toward others, i.e., has feelings of persecution <br />16. Secretive or furtive <br />17. Memory problems (difficulty recalling instructions, data, past behaviors) <br />18. Frequent colds, flu, excessive fatigue, or other illnesses <br />19. Makes unreliable or false statements <br />20. Unrealistic self -appraisal or grandiose statements <br />21. Temper tantrums or angry outbursts <br />22. Demanding, rigid, inflexible <br />23. Major change in physical health <br />24. Concerns about sexual behavior or sexual harassment <br />E. PHYSICAL INDICATORS <br />YES NO <br />1. Smell of alcohol an breath or person? <br />2. Speech: Slurred? <br />Confused? _ <br />Fragmented? <br />Stow? _ <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 DRUGIALCOHOL PLAN <br />NAT,C'�I4L COMPLIANCE NIA IAGEMENT SERVICE, iNC. (NCMSY 2011 (update 20211- The NGNIS plan is <br />Ole subject of a registered copyright and is protected by copyrighl ?aws In kOe U.S. and elsewher? All rights <br />reserved <br />58 <br />