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t'- <br />ACKNOWLEDGMENT OF RECEIPT OF POLICY AND RELATED INFORMATION <br />I have received a copy of the Transportation Employee Drug and Alcohol Policy and have been <br />provided information on the following; <br />1. The person designated by the City of Orono to answer questions about these <br />materials; <br />2. Who is subject to alcohol misuse and controlled substance requirements; <br />3. Explanation of a safety-sensitive function; <br />4. What driver conduct is prohibited; <br />5. Circumstances for drug and/or alcohol testing; <br />6. <br />7. <br />8. <br />9. <br />10. <br />11. <br />Procedures used to test for the presence of drugs and/or alcohol; <br />The requirement that employees submit to controlled substance and alcohol <br />testing; <br />An explanation of what constitutes a refusal to submit to testing; <br />The consequences for drivers violating the prohibitions of this rule, including the <br />immediate removal of the driver from safety-sensitive functions; <br />The consequences for drivers found to have an alcohol concentration level of 0.02 <br />or greater, but less than 0.04; and <br />Information concerning the effects of alcohol and controlled substances use on an <br />individual’s health, work, and personal life. Signs and symptoms of an alcohol <br />or controlled substances problem and available methods of intervening when an <br />alcohol or a controlled substances problem is suspected, including confrontation, <br />referral to an employee assistance program, and/or referral to management. <br />Sicnamre:Date; <br />Please print name; <br />0«J«V5 1