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<br />. <br /> <br />CITY OF ARDEN HILLS <br /> <br />ACKNOWLEDGEMENT OF RECEIPT OF POLICY AND PROCEDURES <br /> <br />TRANSPORTATION EMPLOYEE DRUG AND ALCOHOL MODEL POLICY <br />UNDER THE OMNIBUS TRANSPORTATION EMPLOYEE TESTING ACT <br /> <br />I have received a copy of the Transportation Employee Drug and Alcohol Policy and have been <br />provided information on the following: <br /> <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7, <br /> 8. <br /> 9. <br />. 10, <br /> 11. <br /> <br />The person designated by the City of Arden Hills to answer questions about these <br />materials; <br />Who is subject to alcohol misuse and controlled substance requirements; <br />Explanation of a safety-sensitive function; <br />What employee conduct is prohibited; <br />Circumstances for drug and/or alcohol testing; <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 employees violating the prohibitions of this rwe, including <br />the immediate removal of the employee from safety-sensitive functions; <br />The consequences for employees found to have an alcohol concentration level of <br />0.02 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 or <br />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 /> <br />Employee Signature: <br /> <br />Date: <br /> <br />Please Print Name: <br /> <br />. <br /> <br />15 <br />