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<br />e <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 TraJ1sportation Employee Drug aJ1d Alcohol Policy aJ1d have been <br />provided information on f11e following: <br /> <br /> 1. <br /> 2, <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7, <br /> 8. <br /> 9. <br />e 10, <br /> 11. <br /> <br />The person designated by f11e City of Arden Hills to aJ1swer questions about f11ese <br />materials; <br />Who is subject to alcohol misuse aJ1d controlled substaJ1ce requirements; <br />ExplaJ1ation of a safety-sensitive function; <br />What employee conduct is prohibited; <br />CircurnstaJ1ces for drug aJ1d1or alcohol testing; <br />Procedures used to test for the presence of drugs aJ1d1or alcohol; <br />The requirement f11at employees submit to controlled substaJ1ce aJ1d alcohol <br />testing; <br />An explaJ1ation of what constitutes a refusal to submit to testing; <br />The consequences for employees violating the prohibitions of this rule, including <br />f11e immediate removal off11e employee from safety-sensitive functions; <br />The consequences for employees found to have aJ1 alcohol concentration level of <br />0.02 or greater, but less thaJ1 0.04; aJ1d <br />Information concerning the effects of alcohol aJ1d controlled substances use on aJ1 <br />individual's healf11, work, aJ1d personal life, Signs aJ1d symptoms of an alcohol or <br />controlled substances problem aJ1d available mef110ds of intervening when an <br />alcohol or a controlled substaJ1ces problem is suspected, including confrontation, <br />referral to aJ1 employee assistaJ1ce program, aJ1d1or referral to maJ1agement. <br /> <br />Date: <br /> <br />Employee Signature: <br /> <br />e <br /> <br />Please Print Name: <br /> <br />15 <br />