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Attachment D
<br />BUILDING AND CONSTRUCTION RESOURCE CENTER INC.
<br />AUTHORIZATION FOR CONSENT TO DRUG AND ALCOHOL
<br />ANALYSIS AND AUTHORIZATION FOR RELEASE OF RESULT'S
<br />I, the undersigned, - do hereby, authorize the testing army body fluids
<br />forenrployment reasons and understand and agree that the resells of any such testing will be turned
<br />over to the Building and Constructions Resource Center, Inc. and, further than the testing procedures
<br />will be limited to tests for prohibited and illegal drugs and conlrolled substances
<br />-
<br />I understand that rite resells of these tests may be used for employment and disciplinary reasons and
<br />hereby authorize the release of such information from Ihelaboralmy and MRO.
<br />I further certify that the urine specimen collected from me is nine end not adulterated or altered in
<br />any manner. I have been advised that matters affecting me relative to the inlerpretation or
<br />application of the Dmg Policy and subject esclwively to the grievance and arbitration procedure
<br />under my collective bargoining agreement (irapplicable).
<br />Attachment F
<br />Signature of Applicanl/Employee
<br />Employee's Social SecurityNumbcr
<br />Time Employee's l'clephone Numbcr
<br />Employee's Address
<br />Slate & Zip Code
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<br />Drug and Alcohol Policy
<br />in compliance I, till
<br />49 CFR Prn9 dQ and
<br />49 CFR Par! 382 (FA1CSA)
<br />far
<br />DOT -Covered Contractor Participauls
<br />BCRC Board Approved Augusa ]s, 7004
<br />BUILDING and CONSTRUCTION RESOURCE CENTER
<br />(BCRC)
<br />Drug and Alcohol Policy
<br />in compliance with
<br />49 CPR Part 40, and
<br />49 CFR Par( 392 (FMCSA)
<br />for
<br />DOT -Covered Contactor Participants
<br />BCRC Board Approved August 18, 2004
<br />1. PURPOSE
<br />Bu€ldiag and Cansimciion Resource Crater ("BCRC",'yhe Association") has established
<br />this alcohol and controlled substances testing program for contractor participants who
<br />have employees that we drivers of Commercial Motor Vehicles (CMVs) and uhO require
<br />Commercial Drivers Licenses (CDIs), to meet requirements of the U.S, Department of
<br />Tramportntion (DOT). The overall goals of this testing program are to ensure a safe and
<br />drug -free transporlation environment, In reduce the potential for accidents and casualties
<br />related to accidents involving Company -mewed 1-leased vehicles, and to cooperate with
<br />the U.S. Department of Transportation and the transportation industry in efforts to
<br />eliminate the misuse of alcohol and the illegal use of controlled substances by our
<br />drivers.
<br />With these objectives in mind, BCRC has established the following policy and
<br />procedures for DOT -Covered employees ofits comaclor participants. Full compliance
<br />with this policy is a condition ofemployment with each individual contractor.
<br />11. SCOPE
<br />13CRC's Drug and Alcohol Policy for DOT- Covered Employees, outlined below, applies
<br />to all full-time, part-1€me, and temporary employees who are "covered drivers' as defsncd
<br />in Section VI (A). This policy also corers independent drivers who may be spoail€cally
<br />named in a contract to provide service In addition, dus policy covers a€€ job applicants
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<br />Attachment E
<br />BCRC APPLICANT/CARDHOLDER. DRUG TEST
<br />©CRC is exercising extreme care to ensure that strict quality control measures are followed in
<br />the collection, handling, and analysis of you specimen You play an important role in this
<br />process and should be certain dial you have provided an unadulterated specimen to the
<br />laboratory. Remember, you are certifying that the specimen Much you provide is yours and is
<br />unadulterated. Anyadullemtion or switching of specimen is o breach of UCRC's roles and, if
<br />you are employed, may subject you to discipline up to and including termination by your
<br />employer.
<br />Far your our protection and pence of mind, vve ask thatyou:
<br />• Provide a picture identification to the collection site/lechnieian at lime of arrival;
<br />• He escorted to a collection mom and asked to provide an unadulterated specimen in
<br />the collection bottle provided. The bottle should be filled to 60 ad;
<br />• Return the specimen bottle to the medical technician and witness, initial and date the
<br />integrity seals placed on your specimen;
<br />• Verify the proper spellingofyour name as recorded on the log sheet;
<br />• Verify that your social security number has been properly recorded;
<br />• Verify that the social security number placed on your specimen bottle is the same as
<br />that recorded on dicing sheet and the Chain ofCuslody' form.
<br />I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY TO ASK
<br />QUESTIONS REGARDING THIS PROCEDURE.
<br />BCRC ApplicenUCmdholder5ignature Date
<br />h71
<br />IV.
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<br />for positions that require Commercial Drivers Licenses (CDL) for the operating of
<br />Commercial Motor Vehicles as described in Section VI JAI.
<br />In those circumstances that are not addressed by DOT regulations or in this policy, DOT -
<br />covered employees remain subject to rules and testing as defined in DCRC's Drug and
<br />Alcohol Policy for all employees.
<br />in addition, a driver will be required to submit to a non -DOT test for reasonable suspicion
<br />in those circumstances when the driver is suspected of drug or alcohol use, orhas
<br />violated a work mle as staled elsewhere in this policy, oris involved in or may have
<br />contributed to the causing of an accident, or causes injury to him4terself or to another
<br />person, Wien thecircunnslances related to that incident do not meet the requirements Ora
<br />DOT lest.
<br />REFERENCES
<br />Title 49 CFR §382, et al., Federal Motor Carrier Safely Administration (FMCSA)
<br />Regulations on Controlled Substances and Alcohol Use and Testing
<br />Title 49 CFR §40, Procedures For Tyrairsporlation Work lace Dm and Alcohol Teslin
<br />Programs
<br />Title 41 U.S.C. §§ 403, 701 el. Seq., Drug -Free 3Varkpiace Act of 1998.
<br />Note: If there ere conflicts between federal regulations and Otis policy, attributed in part
<br />to revisions to the law or changes in inlerpretaiions, and when those changes have not
<br />been updated oraccuralely sellecled in this policy, the federal law shoal prevail.
<br />POLICY! RULES OF CONDUCP
<br />A driver who violates the FMCSA prohibitions of this policy (Section VIIBj), including a
<br />refusal to be tested, must be inmtedialely removed from all FMCSA safety' -sensitive
<br />functions, including driving, in accordance pith 49 CFR Part 382 501, FMCSA rules and
<br />regulations. Under each employer's independent authority, the driver will be subject to
<br />discipliner)' action up to and including termination of emptoy'menl-
<br />An employer also reserves the right to take action against an employee, where
<br />appropriate, for i iolat€on of other general employer policies, procedures and/or rules that
<br />may be defined in rues that are separate from this policy for DOT -covered employees.
<br />A. A corered driver may not engage in any of the conducl(s) prohibited in Section
<br />VI IBj.
<br />B_ Under independent authority, BCRC prohibits the possession of alcohol, or the
<br />sale, purchase, manufacture, possession or transfer of rat illegal drug, or being
<br />under the influence of alcohol or of am illegal drug, during all cork lime,
<br />including meals and breaks, Or at any lime white on Company property, at a
<br />Company's job site, shipperlreeeiver site, truck slap, rest area, on Company
<br />business, or in a Company -owned Mcased vehicle. An employee who possesses
<br />alcohol, or who uses alcohol witi€e on duty, will be ler"mrwrl from employment-
<br />C. Under independent authority, BCRC prohibits the use of any over-the-counter
<br />medication by an employee during working time or any time while On Company
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