ML20079C814
| ML20079C814 | |
| Person / Time | |
|---|---|
| Site: | Fort Saint Vrain  |
| Issue date: | 06/18/1991 |
| From: | Crawford A PUBLIC SERVICE CO. OF COLORADO |
| To: | Weiss S NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM), Office of Nuclear Reactor Regulation |
| References | |
| P-91213, NUDOCS 9106260147 | |
| Download: ML20079C814 (35) | |
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P.O. Box 840 Denver CO 80201- 0840 June 18, 1991 Fort St. Vrain A. Clegg Crawford Unit No. 1 Vice Pre 5' dent p,g Nuclear Operations U. S. Nuclear Regulatory Commission ATTN: - Document Control Desk Washington, D. C.
20555 ATTN:
Mr. Seymour H. Weiss, Director Non-Power Reactor, Decommissioning and Environmental Project Directorate Docket No. 50-267
SUBJECT:
Fort St. Vrain Fitness for Duty Program
REFERENCE:
1.
NRC Letter, Erickson to Crawford, dated May 21, 1991 (G-91106)
Dear Mr. Weiss:
This letter is to advise the NRC that Public Service Company of Colorado (PSC) is discontinuing its 10 CFR Part 26 Fitness for Duty Program at Fort St.
Vrain (FSV), ef fective August 1,1991. This action is being taten consistent with the permanent shutdown condition of the plant, as confirmed by our receipt of the FSV possession only license (Reference 1).
The requirements of 10 CFR Part 26 are only applicable for a licensee authorized to construct or operate a nuclear power reactor, as defined in 10 CFR 26.2.
PSC is committed te maintaining a safe drug free work environment at Fort St. Vrain.
Our Company Fitness for Duty Program, which includes drug and alcohol
- policies, training provisions, and an Employee Assistance Program, will continue to apply-to all PSC employees associated with Fort St. Vrain.
In addition, until all nuclear fuel is removed from the reactor building, random drug screening will be applied to selected groups of FSV workers.
The selection of these groups is currently under consideration, but it will include individuals with access to FSV fuel, and emergency response personnel. A copy of PSC's Fitness For Duty Policy is-attached for your information.
9106260147 910618
[DR ADOCK 05000267
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P-91213
'Page 2 June 18, 1991 If you have any quo tions regarding the FSV Fitness For Duty Program, please contact Mr. M. H. Holmes at (303) 480-6960.
Very truly yours, 27 dab n
?
yp A. Clegg Crawford Vice President Nuclear Operations ACC/SWC/imb cc:
Regional Administrator, Region IV Mr. J. B. Baird Senior Resident Inspector Fort St. Vrain Mr. Robert M. Quillin, Director Radiation Control Division Colorado Department of Health l
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- 40. FITNESS FOR DUTY (Alcohol and Drugs) 40.0 Policy Our company has a commitment to its employees, customers, shareholders and the public to provide a safe work environment and to provide energy in a safe, efficient manner. All employees shall report for work and remain in a physical and mental condition that enables them to perform their duties. Involvement with ille0al drugs and the use of alcohol or being under the influence of alcohol during work hours will not be tolerated.
40.1 Applicability This policy is applicable to all employees of Public Service Company of Colorado and its subsidiaries.
40.2 Responsibilities A.
Management employees are responsible for:
- 1) Assuring that the employees under their supervision are capable of performing their work assignments in a safe and efficient manner.
- 2) Identifying personnel who appear to be under the influence of alcohol and/or O
using non-medically authorized drugs.
B.
Each employee is encouraged to report to management any violation of the Fitness for Duty Policy.
40.3 Drugs A.
Any employee who uses, possesses, buys, sells, distributes or is under the influence of illegal drugs while on duty, including paid and unpaid meal periods, or while on property owned or leased by the company, is in violation of this policy and is subject to disciplinary action, up to and includin0 discharge.
B.
Any employee testing positive for drugs, pursuant tr' laboratory testing procedures, is in violation of this policy, will be referred for medical evaluation and !s subject to disciplinary action, up to and including discharge.
C.
Employees undergoing medical treatment with a prescribed medication or taking over-the-counter medication which may alter their physical or mental abilities to perform their duties must report this treatment to their supervisor. Employees who abuse over-the-counter or prescribed medication are in violation of this policy and are subject to disciplinary action, up to and including discharge.
40.4 Alcohol O
anv emnievee whe eeee. er ie ender 18e infiecece of ee eicohei>c bevere0e whiie em duty, including paid and unpaid meal periods, or while on property owned or leased by 40-1 Rev 9
the company,is in violation of this policy and is subject to disciplinary action, up to and including discharge.
40.5 Employee Assistance Employees with an alcohol or drug problem are encouraged to seek hoip. An Employee Assistance Program (EAP) is provided for employees of the company. The program provides confidential assistance to employees in problem identification, evaluation, counselling and referral services for emotional, behavioral, medical, personal and chemical dependency problems which may be experienced by employees and their f amilies no matter what the cause. By charter, the EAP does not enforce the Fitnest.or Duty Policy. An employee who voluntarily self-refers to the EAP for assistance will not be disciplined for such self-referral or subsequent treatment. However, volunteering to seek EAP assistance or to participate in a treatment program will not prevent disciplinary action if an employee has been instructed to submit to testing procedures or is already under investigation or suspension for a violation of the Fitness for Duty Pohcy.
40.6 Definitions 40.6.1 Candidate An applicant for employment (regular, probationary, part-time or temporary) with the company who has been offered a position and is undergoing the pre-employment processing.
40.6,2 Collection Site A designated place where individuals present themselves for the purpose of providing a specimen of urine, breath or blood to be analyzed for alcohol or drugs.
40.6.3 Collection Site Person A person who instructs and assists employees at a collection site, and who receives and makes an initial examination of the specimens provided by those employees. A collection site person shall have completed training to carry out this function, or shall be a licensed medical professional or technician who is provided instructions for collection.
40.6.4 Commercial Motor Vehicle A vehicle used in interstate commerce:
A.
Havmg a gross weight of 26,001 or more pounds; or B.
Designed to transport more than 15 passengers, including driver; or C.
Used in the transportation of hazardous materials in quantity requiring placardmg.
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4 40.6.5 Company Public Service Company of Colorado and its subsidiaries.
40.6.6 Company Property Property, land and buildings owned or leased for use by the cornpany where employees may be expected to work, and company vehicles or equipment, including vans used for commutin0 o and from work.
t 40.6.7 Contractor Any company or individual perforrning work or providing an operating, maintenance or emergency response function on a gas pipeline or gas facihty that is governed by Department of Transportation (DOT) regulations (49CFR192,193 or 195) or a company performing work governed by the Nuclear Regulatory Commission (NRC). The contract may be written, a purchase order or a verbal agreement.
40.6.8 DHHS United States Department of Health and Human Services or any designee of the Secretary, Department of Health and Human Services.
40.6.9 DOT p
United States Department of Transportation.
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l 40.6.10 DOT Reportable Accidents A.
Motor Vehicle Accident (49CFR394.3).
An accident which results in death of a human being or bodily injury to a person who, as a result of the injury, immediately receives medical treatment away from l
the scene of the accident; or total damage to all property aggregating $4,400 or more based upon actual costs or reliable estimates.
l B.
Gas Facility Accident (49CFR191).
- 1) An event that involves a release of gas from a pipeline which resulted in a death or personal injury necessitating in-patient hospitalization; or property damage, including the cost of gas lost by the operator or others or both of
$50,000 or more.
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- 2) An event that is significant, in the judgement of the operator, even though it did not meet the criteria of B.1) above.
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40.6.11 Employee An individual, who is assigned a specific full-time or part-time position with the cornpany.
O 40-3 Rev 9
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40.6.12 Follow up Screening A screening conducted at unannounced intervals, to ensure that an employee is maintaining abstinence from the abuse of drugs.
40.6.13 For Cause A reasonable belief that an employee is using alcohol or drugs or that an employee's performance or behavior is being affected by the use of alcohol or drugs.
40.6.14 Inactive Employment Status Any employee who is on leave of absence (military, personal, pregnancy, unica service), long term disability or termination.
40.6.15 Meal Periods Pertaining to the use of alcohol, paid and unpaid meal periods do not include overtime meals at the end of a work period if the employee eats the meal off company property, is not driving a company vehicle and will not return to duty at the conclusion of the meal.
40.6.16 Medical Review Officer (MRO)
A licensed physician responsible for receiving laboratory results generated by the drug screening program who has knowledge of substance abuse disorders and has appropriate medical training to interpret and evaluate an employee's positive test results together wi'.h his or her medical history and any other relevant biomedical information.
40.6.17 NRC The United States Nuclear Regulatory Commission.
40.6.18 Random Selection Process A.
A selection process that is on a random and unannounced basis. The tests shall be administered so that a person completing a test is immediately eligible for another unannounced test. As a minimum, tests shall be admimstered on a nominal monthly frequency and at various times during the day. Random tests y
conducted annually shall equal 50 percent of the total number of employees in the i$8 p v
random pool.
B.
ain, te i be adm on a n at various times during the day. Random tests conducted annually shall equal 100 percent of the total number of employees in the random pool.
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- ^m__A.
D 40.6.19 Screening l
A.
The overall process of having the employee or candidate provide a specimen (s),
h having the specimen (s) analyzed (tested) by a certified laboratory, and notifying the 40-4 Rev 9
necessary personnel of the test results. In screening "For Cause", the specimen (s) may be urine, blood, breath or any combination thereof.
'l B.
Employees on leave of absence, sick leave, long term disability, permanent total disability or temporary total disability under workers' cornpensation, or those who are released for union activity shall not be required to submit to screenin0 for actions while on such status.
40.6.20 Testing The analytical process conducted by a DHHS certified laboratory.
40.7 Specific Responsibilities 40.7.1 Auditing Manager Performs audits of the company and contractor programs to ensure cornpliance with company policy and governmental regulation.
40.7.2 Contractors All contractor personnel performing DOT or NRC regulated activities within the scope of this policy are subject to either the company's procedures or to pr, cedures formally reviewed and approved by Public Service Company.
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40.7.3 Division Manager A.
Notifies current DOT regulated contractors, in writing, of their responsibilities to have a drug program in compliance with governmental regulations.
B.
Ensures that all future contracts with DOT regulated contractors include a provision for compliance with governmental regulations.
C.
Except in Denver Metropolitan Area, ensures that all candidates for employment are referred to approved collection site for Fitness for Duty screening.
D.
Ensures that employees transferring to gas department positions covered by DOT regulations have completed screening prior to their first work shitt, or that they are already participating in random screening.
E.
Adds and deletes employees from the random drug screening list, as required. The Personnel Action Form (PAF) will be used for this purpose.
F.
Ensures that all new supervisory personnel are scheduled for management alcohol and drug training within three (3) months of their initial supervisory assignrnent.
l 40.7.4 Employee Responsible for conforrning to the provisions of this procedure.
40-5 Rev 9
- - - _ ~
4 40.7.5 Employee Assistance Program Coordinator A.. Advises employees on rehabilitation programs and-the Employee Assistance h
Program.
B. Consults with management concerning the Employee Assistance Program.
C. Conducts employee assessments to determine the level of abuse and treatment.
40.7.6 Employment Director A.
Ensures that all candidates for employment in the Denver Metropolitan Area are referred to the Medical Department for Fitness for Duty screening.
- B.
Ensures that no candidate is hired until successfully passing the Fitness for Duty screening.
40.7.7 Labor Relations Director A.
Provides, when requested, guidar,ce and counsel to all concerned on matters of discipline.
B.
Reviews all discipline applied under this program for consistency.
40.7.8 Legal Advisor (Kelly, Stansfield and O'Donnell)
Provides legal guidance and counsel to management.on matters relating to this h
- program, 40.7.9 Management Employee A.
Ensures that er :ployees conform to the company's Fitness for Duty Policy.
B. - Provides, when requested, guidance and counsel to all concerned on matters.of discipline and the appeals process associated with this procedure.
C.
Initiates the action detailed in these procedures whenever he or she believes that an employee may be unfit for duty.
D.
Initiates the disciplinary process and/or refers the employee to the Employee' l
Assistance Program for assessment.
E.
Ensures employees returning to work from inactive employment status of ninety-(90) calendar days or more complete a drug screen.
40.7.10 - Medical Review Officer A.
Serves as liaison between the company and the testing physicians, collection sites and certified laboratories.
B.
Ensures collection procedures are conducted in accordance with the Department of Health and -Human Services (DHHS) Guidelines for Federal Drug Testing
' Programs.
O C.- Ensures that specimens are tested by a DHHS certified laboratory, j
40-6 Rev.9
D. Determines that employees who have completed a rehabilitation program are medically fit to return to duty,
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E.
Serves as liaison between the company and candidates for employment whose screening examinations are positive.
F.
Provides the Safety and Security Director with:
- 1) The names of those employees requiring follow-up screening,
- 2) Statistical reports on a monthly basis.
40.7.11 Payroll / Human Resource information Center Director A,
Develops and maintains a computer program which will select identified employees on a random basis for screening, B.
Provides to the Safety and Security Director, each month, a hst of employees selected for random screening.
40.7.12 Safety and Security Director A.
Functions as the administrator for the Fitness for Duty Program and is responsible to oversee and evaluate its operation.
B.
Schedules designated employees for random screening.
C.
Schedules employees for follow up screening as identified in paragraph 40.12.10.
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40.7.13 Training and Development Director A.
Gives mana0ement personnel training in alcohol and dru0 awareness and behavioral observation techniques.
B.
Provides employee orientation of the Fitness for Duty Policy and Procedure.
C.
Places in each employee's f cd of training.
40.8 Pre-Employment Screening Procedure 40.8.1 Summary This is the company's procedure for determining the fitness for duty of candidates for company employment.
A.
Pre-employment screening for dru0s shall be conducted on all candidates prior to employment.
B.
Any employee who is on inactive employment status for 90 days or more will be re-screened for drugu before being allowed to return as an employee.
40.8.2 Procedures l
A.
Pre-employment screenin0 - Denver Metro Area.
40-7 Rev 9
- 1) Collection, a) Employment Director:
h Sets appointment with Medical Department for candidate's physical.
b) Candidate:
1.
Lo0s in at the Medical Department and presents photo identification to receptionist and nurse. If candidate has no photo identification, he or she will not be allowed to complete the screening process.
ii. Completes and signs urine custody and control form in presence of collection site personnel, iii. Completes screening examination under direction of nurse in conformance with Medical Department collection protocol.
c) Laboratory:
Performs analysis, sends written results to Medical Review Officer.
- 2) Test Results Negative.
a) A test result less than the cutoff levels identified in paragraph 40.12.6.8.
shall be reported as negative.
b) Medical Review Officer:
i.
Telephones Employment Director giving candidate's name and social security number. Assuming all other physical qualifications are met, h
states:
"The candidate passed the pre-employment examination."
Signs and forwards employment application to Employment Department, ii. Files laboratory results.
c) Employment Director:
h Completes hiring process.
- 3) Test Results Positive.
a) A test result that meets or exceeds the cutoff levels identified in paragraph 40.12.6.B. shall be reported as positive.
b) Medical Review Officer:
1.
Telephones Employment Director, giving candidate's name and social security number, stating: "The candidate failed the pre-employment examination."
Signs and forwards employment application to Employment Department.
li. Files laboratory results, c) Employment Director:
1.
Advises the candidate that he or she failed the medical examination and wili not be hired. The candidate is precluded from reapplying for h
a period of six months.
40-8 Rev.9 6
il. Advises the candidate that by appointment and with proper identification, the Medical Review Officer wdl provide a complete O
review of the exarnination results.
B.
Pre-employment screening other than Denver Metro Area
- 1) Collection, a) Division Manager:
i.
Sets appointment for candidate's physical and sends him or her to an authorized collection site for drug screening (See 40.12.2 for collection sites).
16.
Notifies the Medical Review Officer that a candidate has been sent for screening.
b) Candidate:
i.
Logs in at the collection site and presents photo identification to collection site personnel. 11 the candidate has no photo identification, he or she will not be allowed to complete the screening process.
ii. Completes and signs urine custody and control form in the presence of collection site personnel, iii. Completes screening examination under the direction of collection site personnel in conformance with Medical Department collection protocol.
c) Laboratory:
Performs analysis, sends written results to the Medical Review Officer.
- 2) Test Results Negative.
a) A test result less than the cutoft levels identified in paragraph 40.12.6.B.
shall be reported as negative.
b) Medical Review Officer:
i.
Notifies the hiring Division Manager that the candidate passed the pre-employment examination.
ii. Telephones results to the Employment Director giving candidate's name and social security number.
Assuming all other physical quahtications are
- met, states:
"The candidate passed the pre-employment examination /
Signs and forwards employment application to Employment Department.
iii. - Files laboratory results.
c) Division Manager:
Continues hiring process.
d) Employment Director:
Completes hirin0 process.
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- 3) Test Results Positive.
a) A test result that meets or exceeds the cutoff levels identilied in paragraph g
40.12.6.B. shall be reported as positive.
b) Medical Review Officer:
1.
Notifies the hiring Division Manager that the candidate failed the pre-employment examination.
ii. Telephones Employment Director. D ving candidate's name and social i
security number, stating: "The candidate failed the pre-employment examination."
Signs and forwards employment application to Employment Department.
iii. Files 17 oratory results.
c) Division Manager:
i.
Advises the candidate that he or she failed the medical examinotion and will not be hired. The candidate is precluded from reapplying for a period of six months.
ii. Advises the candidate that by appointment and with proper identification, the Medical Review Officer will provide a complete review of the examination results.
C.
Scrocoing of employees returning to work from inactive Employment Status of 90 calendar days or more.
- 1) Collection, a) Employee:
Advises management that he or she wants to return to work, b) Employee's management:
i.
Sets appointment with Medical Department or collection site.
ii. Notifies employee of the screenin0 appointment.
iii. If employee refuses to undergo screening. advises employee that he or she will not be allowed to return to work.
c) Employee:
Provides explanation for his or her refusal, d) Employee's management:
1.
II explanation seems to provide legitimate reason not to screen, seeks agreement from Medical Review Officer, ii. If explanation is unsatisfactory, requests the employee to undergo screening.
iii. ll employee still refuses to undergo screening, places the employee on indefinite suspension without pay.
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e) Employee:
O i.
Reports directly to the Medical Department or collection site (See U
40.12.2 for site locations).
ii. Completes screening, f)
Collection Site Personnel:
If employee refuses to complete screening, immediately advises i
employee's supervision prior to allowing amployee to leave the facility.
Management employee repeats steps 1)b)ili, and 1)d)ili. above.
g) Medical Review Officer:
Receives test results fron Laboratory.
- 2) Test Results Negative, a) A test result less than the cutoff levels identified in paragraph 40.12.6.A.
shall be reported as negative.
b) Medical Review Officer:
- i. - Telephones employee's management of a negative test result.
ii. Files laboratory results.
c) Employee's management:
Advises employee of the test results and schedules return to work.
- 3) Test Results Positive.
a) A test result that meets or exceeds the cutoff levels identified in paragraph 40.12.6.A. shall be reported as positive, b) Medical Review Otficer:
i.
Contacts employee directly, on a confidential basis, to provide employee an opportunity to discuss test results. See 40.12.7.B. for complete procedure.
ii. After discussion with employee and verification of a positive test result, notifies employee's management.
iii. Files laboratory results.
c) Employee's mana0ement:
1.
Discusses problem with employee. Informs employee that this is now an investigative interview, which could lead to disciplinary action, and he or'she is entitled to union representation, if represented by the union.
ii. Provides the employee on opportunity-to explain the reason for the positive test result.
iii. Advises employee that he or she is on indefinite suspension, without pay, pending results of the investigation. Tells the employee that he 40-11 Rev.9
or she will be contacted as to when to return for the results of the investigation -
O iv. May refer employee to the Employee Assistance Program for rehabilitation assessment. Seeks advice from Labor Relations and Legal, as necessary. Determines disciplinary action or employment status.
v, Advises employee of the results of the investigation and employment
- status, vi. If employee is going to be given the opportunity to return to work, ensures employee is precluded from working until successfully completing a rehabilitation program, abiding by a re-entry agreement and be?ng released by the Medical Review Officer.
d) Employee:
1.
Upon written request, has access to any records relating to his or her drug test and any records relating to the results of any relevant laboratory certification review, or laboratory revocation of certification proceedings, ii.' For information concerning the employee's right to have a retest of the original specimen, see 40.12.9.
40.9 Pre-Placement Screening Procedure 4-40.9.1 Summary This is the. company's procedure for determining the fitness for duty of employees-transferring to company positions covered by governmental regulation.
A.
Pre-placement screening, for drugs only, shall be completed before transferring to a gas department position covered by DOT regulations. This screening will not be-required if the employee being transferred is already participating in random-
- screening.
B.
Pre-access screening for alcohol and drugs shall be completed before transferring -
to or obtaining employment at Fort St. Vrain which requires unescorted access to the protected area, Screening at Fort St. Vrain shall be in accordance with current nuclear policies and procedures.
40.9.2 Procedures A.'
Employee:
Applies for a company position covered under governrnental regulation.
B.. Hiring supervisor:
-1) Advises employee that as a condition of the new position, a pre-placement drug g
screening must be conducted.
40-12 Rev.9 -
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- 2) Advises employee that upon successful completion cf the screening and q
assignment to the new position, the ernployee will be added to the list of
(,y employees subject to random drug screerdng.
C.
Employee:
- 1) Completes pre-placement screening; or
- 2) Declines to complete pre-placement screening and continues in current position.
D.
Medical Review Officer:
Roccives test results from laboratory.
40.9.3 Test Results Negative A.
A test result less than the cutoff levels identified in para 0raph 40.12.6.A. shall be reported as negative.
B.
Medical Review Officer:
- 1) Telephones hiring supervisor of a negative test result.
- 2) Files laboratory results.
C.
Hiring supervisor:
- 1) Advises employee of the test results.
(
- 2) Adds employee's name to the list of employees subject to random drug screenmg.
40.9.4 Test Results Positive A.
A test result that meets or exceeds the cutoff levels identified in paragraph 40.12.6. A. shall be reported as positive.
B.
Medical Review Officer:
- 1) Contacts employee directly, on a confidential basis, to provide employee an opportunity to discuss test results. See 40.12.7.B. for complete procedure.
- 2) After discussion with employee and verification of a positive test result, notifies employee's current management and hiring supervisor.
- 3) Files laboratory results.
C.
Ernployee's current management:
- 1) Discusses problem with employee. Informs employee that this is now an investigative interview, which could lead to disciplinary action, and he or she is entitled to union representation, if represented by the union.
- 2) Provides the employee an opportunity to explain the reason for the positive test result.
- 3) Advises employee that he or she is on indefinite suspension, without pay, pending results of the investigation. Teils the employee that he or she will be contacted as to when to return for the results of the investigation.
40-13 Rev 9 l
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..._- =-
- 4) May refer employee to the Employee Assistance Program for rehabilitation assessment. Seeks advice from Labor Relations and Legal, as necessary.
Determines disciplinary action or employment status.
5)- Advises employee of the results of the investigation and employment status.
- 6) Il employee is going to be given the opportunity to return to work, ensures employee is precluded from working until successfully conipleting a rehabilitation program, abiding by a re-entry agreement and being released by the Medical Review Officer.
D.
Employee:
- 1) Upon written request, has access to any records relating to his or her drug test and any records relating to the results of any relevant laboratory certification review, or laboratory revocation of certification proceedings.
- 2) For information concerning the employee's right to have a retest of the original sample, see 40.12.9.
40.10 For Cause Alcohol and Drug Screening Procedure 40.10.1 Summary This is the company's procedure for determining an employee's fitness for duty, it focuses on testing to determine the use of alcohol or drugs. The company may require an employee to undergo a screening for alcohol and/or drugs in cases:
A.
Where an employee's behavior or job performance suggests the employee may be under the influence of alcohol or using alcohol or drugs.
B.
Where information which, after investigation, provides reasonable cause to believe an employee may be under the influence of alcohol or using drugs.
C.
Where a DOT _ reportable accident has occurred.
- 1) Each employee whose performance either contributed - to, or cannot be completely discounted as a contributing factor to a DOT reportable gas facility.
accident, shall be tested for drugs as soon as possible, but no later than 32 hours3.703704e-4 days <br />0.00889 hours <br />5.291005e-5 weeks <br />1.2176e-5 months <br /> after the accident.
Atter such an accident, testing may be unwarranted when, based on the best information available, it-is determined that an employee's performance could not have contributed to the accident.
- 2) Each employee who was involved in a DOT reportable motor vehicle accident -
and who receives a citation for a moving traffic violation arising from the accident shall be tested for drugs as soon as possible, but no later than 32-hours after the accident.
D.
At the discretion of.the company or as required by governmental regulation, after an on-the-job accident in which a serious work injury or substantial damage to property has occurred.
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j 40.10.2 Procedures All procedures in this section are displayed in the "For Cause Screening Procedures" Flow Chart (Attachment 1).
A.
Management employee:
- 1) Completes " Fitness for Duty Checklist"(Attachment 2).
- 2) Has one additional member of management substantiate and concur in the decision to test an employee.
Either the management employee or the additional member of management shall be trained in detection of the possible symptoms of drug use.
- 3) Confronts employee, explains cause for concern and removes employee from job assignment.
B.
Employee:
Provides explanation for his or her job performance or behavior.
C.
Management employee:
- 1) If explanation is unsatisfactory, requests employee to undergo screening.
- 2) If employee refuses to undergo screening, advises employee that refusal to participate in the screening program will:
a) Bn deemed insubordination, and employee will be subject to discharge, b) Result in immediate removal from present job assignment.
c) in the case of a DOT regulated driver involved in a fatal motor vehicle
. accident, result in a Letter of Disqualification for a period of one (1) year.
- 3) If employee still refuses to undergo screening, places the employee on indefinite suspension without pay.
- 4) If employee agrees to undergo screening, contacts the Medical Review Officer and schedules the employee for screening. The on-duty Medical Review Officer can be contacted by telephoning; a) 571-7000 during normal working hours, b) The Company Operator. 571-7511, and requesting the on-duty Medical Review Officer.
- 5) Transports employee to collection site (See 40.12.2), or assigns another responsible employee to transport employee. The employee to be screened will not be allowed to drive a vehicle during this process.
D.
Employee:
Completes screening.
E.
Collection site personnel:
If employee refuses to complete screening, immediately advise employee's supervisor prior to allowing employee to leave facility.
Management employee repeats steps C.2) and C.3) above.
40-15 Rev 9
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F.
Management employee:
- 1) Places employee on indefinite suspension, without pay, pending results of the h
test and further investigation. Informs employee that if test result is negative, the time off will not be charged to the employee.
- 2) Arranges to have the employee transported home.
- 3) If the employee refuses transportation to the collection site or home, advises the employee that he or she will be considered to be insubordinate and will be subject to discharge. Advises the employee that local law enforcement will be notified that he or she is driving and that the company believes that he or she is not fit to drive.
G.
Medical Review Officer:
Receives test results from labora'ory.
40.10.3 Test Resu!ts Wgative A.
A test result less than the cutotf ievels identified in paragraph 40.12.6.A. shall be reported as negative.
B.
Medical Review Officer:
- 1) Telephones employee's management of a negative test result.
- 2) Files laboratory results.
C.
Management employee:
g
- 1) Notifies employee of test results.
- 2) Corrects employee's payroll record, if necessary.
40.10.4 Test Results Positive A.
A test result that meets or exceeds the cutoff levels identified in paragraph 40.12.6.A. shall be reported as positive.
t3. Medicat Review Officer:
- 1) Contacts employee directly, on a confidential basis, to provide employee an opportunity to discuss test results. See 40.12.7.B. for complete procedure.
- 2) After discussion with employee and verification of a positive test result, notifies employee's management.
- 3) Files laboratory results.
C.
Management employee:
- 1) Informs employee that this is now an investigative interview, which could lead to disciplinary action, and he or she is entitled to union representation, if represented by the union.
- 2) Provides the employee an opportunity to explain the reason for the positive test result.
- 3) Tells the employee that he or che will be contacted as to when to return.
40-16 Rev 9
l
- 4) Completes the investip tion. Seeks advice from Labor Relations and Legal, as necessary.
O
- 5) Advises employee of the results of the investigation and employment status.
- 6) If employee is going to be given the opportunity to return to work, ensures employee is precluded from working until successfully completing a rehabilitation program, abiding by a re-entry agreement and being released by the Medical Review Officer.
- 7) Issues a Letter of Disqualification to DOT regulated drivers for a positive drug test if they were involved in a fatal accident. The disqualification will remam in effect for a period of one (1) year.
D.
Employee:
- 1) Upon written request, has access to any records relating to his or her dru0 test and any records relating to the results of any relevant laboratory certification review, or laboratory revocation of certification proceedings.
- 2) For information concerning the employee's right to have a retest of the original sample, see 40.12.9.
40.10.5 Inspection A.
Employees, their vehicles and personal property including, but not limited to, tool boxes, gym bags, back packs, lunch boxes, briefcases and purses are permitted onto company property based on the condition that they are subject to inspection O
provided there is reasonable cause to believe such property may contain illegal drugs or alcohol. An exception is possession of unopened alcoholic beverage containers in a personal vehicle parked on company property.
B.
Company property, such as lockers, desks and tool boxes issued to employees in conjunction with their employment is subject to inspection.
C.
An employee who refuses to submit immediately to such an inspection of his or her vehicle or other property shall be considered insubordinate and subject to disciplinary action, up to and including discharge.
D.
If it is determined at a later date by a court of competent jurisdiction or arbitration, if applicable, that there was no reasonable cause to inspect said vehicles or property, any evidence found shall not be admissible for disciplinary action.
E.
Any st.spected illegal substances confiscated from employees will be turned over to a licensed laboratory for analysis or to the appropriate law enforcement agency.
The law enforcement agency will also be informed of the circumstances under which the substance was seized and the identity of the individual (s) involved.
40.11 Random Drug Screening Procedure 40,11.1 Summary O
This is the company's procedure for determining the fitness for duty of those employees covered by governmental regulation. It focuses on random testing to determine the use of drugs. Management may require an employo to undergo a 4417 Rev 9
random screening for drugs only, if he or she is employed in the following work categories:
A.
Employees who perform an operating, maintenance or emergency response function on natural gas pipelines or gas facilities.
B.
Employees who may be expected to operate a commercial motor vehicle, as defined in the definition section of this procedure, in interstate commerce (across
$1e lines)
_ _. m
~ _.
C, Employees who have unescorted access to the protected area at Fort St. Vrain or
- j who are required to report to the Forward Command Post.
~_-%. m_.__.s ToSe b rem 40,11.2 Procedures All procedures in this section are displayed in the " Random Screening Procedures" flow chart (Attachment 3).
A.
Payroll / Human Resource information Center Director When requested, notifies the Safety and Security Director, by name, of those employees selected for random drug screening.
B.
Safety and Security Director:
Notifies the designated employee's management that the employee has been selected for the random drug screening. If there is a valid reason (sick leave, vacation, leave of absence, etc.) that the employee is unavailable the employee will not be required to be screened as a part of this selection.
C.
Employee's management:
- 1) Notifies employee of the screening appointment.
- 2) If employee refuses to undergo screening, advises employee that refusal to participate in the random screening program will:
a) Se deemed insubordination, and employee will be subject to discharge.
b) Result in immudiate removal from present job assignment.
D.
Employee:
Provides explanation for his or her refusal.
E.
Employee's management:
- 1) If explanation seems to provide legitimate reason not to screen, seeks agreement from Medical Review Officer.
- 2) If explanation is unsatisfactory, requests the employee to undergo screening.
- 3) If employee still refuses to undergo screening, places the employee on indefinite suspension without pay.
F.
Employee:
- 1) Reports directly to the collection site (See 40.12.2 for site locations) as soon as possible after being notified.
- 2) Completes screening.
40-18 Rev.9
~~.. _ -
1
- 3) Returns to work assignment.
O
- o. c iiect'em e'ie ne<ee"mei:
If employee refuses to complete screening, immediately advises employee's supervision prior to allowing employee to leave the facility.
Management employee repeats step C.2) and E.3) above.
H. Medical Review Officer:
Receives test results from laboratory.
40.11.3 Test Results Negative A.
A test result less than the cutoff levels identified in par 3 Graph 40.12.6.A. shall be reported as negative.
8.
Medical Review Officer:
- 1) Telephones employee's management of a negative test result.
- 2) Files laboratory results.
C.
Employee's management:
Advises employee of the test results.
40.11.4 Test Results Positive A.
A test result that meets or exceeds the cutoff levels identified in paragraph 40.12.6.A. shall be reported as positive.
B.
Medical Review Offter:
- 1) Contacts employee directly, or, a co*Wdential basis, to provide employee an opportunity to discuss test results. See 40.12.7.8. for complete procedure.
- 2) After discussion with employee and verification of a positive test result, notifies employee's management,
- 3) Filee laboratory resuus.
C.
Employee's management:
- 1) Discusses problem with employee. Informs employee that this is now an investigative intcrview, which could lead to disciplinary action, and he or she is entitled to union representation, if represented by the union.
- 2) Provides the employee an opportunity to explain the reason for the positive test l
result.
l
- 3) Advises employee that he or she is on indefinite suspension, without pay, pendin0 results of the investigation. Tells the employee that he or she wi!1 be contacted as to v, hen to return for the results of the investigation.
- 4) May' refer employee to the Employee Assistanco Dregram for lehabilitation g
assessment. Seeks advice from Labor Relations and Legal. as necessary.
Determines disciplinary action or employment status.
40-19 Revj]
- 5) Advises employee of the results of the investigation and ernployment status.
- 6) If employee is going to be given the opportunity to return to work, ensuces g
employee is precluded from working until successfully completing a rehabilitation program, abiding by a re-entry agreement and beino released by the Medical Review Officer.
D.
Employee:
- 1) Upon written request, has access to any records relating to his or her drug test and any records relating to the results of any relevant laboratory certification review, or laboratory revocation of certification proceedings.
- 2) For information concerning the emnloyee's right to have a retest of the original sample, see 40.12.9.
40.12 Medical Procedure 40.12.1 Summary A.
This is the compar.y's medical procedure for alcohol and drug screening; pre-employment, random, for cause, post-acc.ident, site access, pre-placement and rehabilitation follow-up.
B.
Specimen collection procedures will be of the highest quality assuring accuracy and conformance to Department of Health and Human Services (DHHS) guidelines.
The privacy of individuals who are screened will be safeguarded.
O 40.12.2 Collection Sites Designated collection sites are:
A.
Public Service Medical Departrnent 550 - 15th Street, Room 650 Denver, Colorado 80202 Telephone: (303) 571-7000 8.
The Drug Screening Center, Inc.
1009 Grant Street, Suite 201 Denver, Colorado 80203 j
Telephone: (303) 860-0185 C.
Alamosa Family Medical Center l
1710 First Street l
Alamosa. Colorado 01101 Telephone: (719) 589-3658 D.
C0HBi Clinic Arapahoe East Medical Center 5440 Conestoga Court Boulder, Colorado 80301 Telephone: (303) 443-0687 E.
Frontier Family Practice 2029 Bluegrass Circle, #200 i
Cheyenne, Wyoming 82009 l
Telephone: (307) 632-1957 40-20 Rev.9 l
F.
La Plata Family Medicine 3235 N. Main O
o"re"Do.co'e' "e 8'ao' Telephone: (303) 259 3110 G.
Lakepoint Medical Center 20029 Upper Bear Creek Road Evergreen, Colorado 80439 Telephone: (303) 674 3370 H.
General Care 1045 Garfield Street Fori Collins, Colorado 80524 Telephone: (303) 482-6620 1.
Fort Morgan Medical 102 W. 91h Avenue Fort Morgan, Colorado 80701 Telephone: (303) 867 5681 J.
nerating Station
,'T6 bC 16805 We!d County Road 191/2 Platteville, Colorado 80651 Teleph no: (303 K.
Mesa Laboratory 2525 North 8th Street Grand Junction. Colorado 81501 Telephone: (303) 242-4243 L.
Southern Colorado Clinic 2002 Lake Avenuo Pueblo, Colorado 81003 Telephone: (719) 560-7111 M. Summit Medical Center P.O. Box 738 Hi0hway 9 and School Road Frisco, Colorado 80443 Telephone: (303) 668-3300 N.
Ran0ely District Hospital 511 S. White Street Ran0ely, Colorado 81648 Telephone: (303) 675-5011 40.12,3 Medical Review Officer Alan W. Burgess, M.D.
PSCo Medical Department 550 - 15th Street, Room 650 Denver, Colorado 80202 5718450; Pager 556-0239 O
40-21 Rev.9
l 40.12.4 Assistant Medical Review Officers A.
Carof A. Lipper, M.D.
h PSCo Medical Departinent 550 - 15th Street, Room 650 Denver, Colorado 80202 5717590; PaDer 55G-0061 B.
Russell W. Simpson, M.D.
PSCo Medical Department
$50 - 15th Street, Room 650 Denver Colorado 00202 b718446; Pager 556-0265 40.12.5 DHHS Certified Laboratory Drugstan Inc.
1119 Mearns Road P.O. Box 2969 Warminster, Pennsylvania 18974 Telephone: (215) 674 9310 40,12.6 Alcohol and Drug Screening Cutoff Levels A.
Random, pre-placement, for cause and returning from inactive employment status drug screenings.
- 1) Tested substances will be limited to macijuana, cocaine, opiates, h
amphetamines and phencyclidine.
- 2) Test results of ernployees will be reported as negative if they are less than the followin0 cutoff levels:
Imtial Conbrmatory Test Test (ng/ml)
(ng/ml)
Marijuana metabolites 100 15 Cocaine metabolites 300 150 Oplate metabolites 300 300 Amphetainines 1000 500 Phencyclidino 25 25
- 3) Specimens collected under this policy shall only be tested as described in this procedure and shall not be used to conduct any other analysis or test.
B, Pre-employment Drug Screenings.
- 1) Tested substances will be limited to those listed below.
O 4422 Rev 9
4
- 2) Test results of candidatos for employment will be repoiled as negative il thcy are less than the following cutoff levels:
Initial Confirmatory Test Test (ng/ml)
(ng/ml)
Marijuana metabolitos 20 15 Cocafno metabolitos 300 150 Oplalo metabohtes 300 300 Amphetamines 1000 500 Phencyclidino 25 25 Barbituratos 300 300 Benrodlaropino 300 300 Methadono 300 300 Methaqualono 300 300 Propoxyphon 300 300
- 3) Specimens collected under this policy shall only be tested as described in this proceduto and shall not be used to conduct any other analysis or test, C,
Alcohol screenin0 An employoo subject to alcohol screening will be considered under the influento of alcohol if the lost results meet c, exceed initial Confirmatory lest Test O
(g) g
[ Fort St. Vrain N
N
)
0.04 %
0.04 %
htb NMeath analysis Breath analysis Other company locations 0.05 %
0.05 %
Breath anal sis Sorum (if availabie) 40.12.7 Procedures A.
Collections.
- 1) Each sito shall have clearly written instructions on collection procedures in conformance with DHHS requirements.
- 2) Each sito shall have adequato security to provent unauthorized access which could compromise the li egrity of the collection process.
l
- 3) No unauthorized personnel shall be permitted in any paii of the designated collection site when urino specimens are collected or stored.
Only the collection site person may handle the specimen prior to its bein0 secured in the mailing container.
- 4) The collottion sito person is responsible for maintaining the into0rity of the specimen collection and transfer, process and ensuring the modesty and privacy of the employeo,
_O s) '"e coiteci>o" s'ie Peree" e" 'i " ve ooix o"e oe"er ""oer "ie or "c<
supervision at any timo.
40 23 Rev9
- 6) When an employee arrives at the collection site, positive identification shall be made with a valid picture ID or identification by the employee's supervisor.
O
- 7) If the employee fails to arrive at the assi0ned time, the collection site personnel shall contact the company's Medical Review Officer.
- 8) A multiple part, carbonless Dru0 Testing Custody and Control form will be completed in the presence of the collector and the employee. Copies will be provided for laboratory, Medical Review Officer, employee. collector and the company. The form shall include:
a) Proprinted specimen identification number unique to each collection.
b) The employee's social security number, entered by the ( ollector, c) The company's name, address and identification nurnber.
d) The Medical Review Othcer's name arid address.
e) Specification for which drugs the specirnen will be tested.
f)
Specification for the reason for which this test is conducted (pre-employment, random, for cause, post-accident, site access, pre placement or rehabihtation follow-up) which shall be entered by the collector.
g) Temperature of specimen, recorded by the collector witiiin 4 minutes.
b) Chain of custody documentation.
i) location of collection site, name of collector, certification statement, date and signature, j)
Laboratory results and cerhfication statement, k) Medical Review Officer's certification statement, date and signature.
1)
Ernployee's name (printed), daytime telephone number, date of birth, certification statement, signature and date, all of which shall be entered by employee.
m) A statement to the donor (employee) allowin0 him or her to make a list of prescription and over-the-counter medications that have been taken.
- 9) Each col:ection sito sha!l have an enclosure where private urination car occur, a toilet for completion of urination, a suitable clean surface for writing and a source of water for washing hands. The site shall be designed or shall uso necessary administrative controls to deter the dilution of specimens.
- 10) The employee shall be asked to remove any unnecessary outer garments such as a coat or jacket that might conceal items or substances that could be used to tamper with the urine specimen. All personal belongings such as purses or briefcases shall remain with the outer garments. Employee may retain his or her wallet, if requested, the employee will be provided a receipt for any personal belongings.
O 40-24 Rev.9
- 11) The employen shall bo instructed to wash and dry hands prior to urinrtion.
After washing hands and before actually providing the specimen m, private, the
.O employee shall remain in the presence of the collection sito person and shall not have access to water fountain, faucet, soap dispenser, cleanin0 agent or-any other materials which could be used to adulterato the specimen.- '
- 12) A clean, single usu, securely wrapped collection container and/of specimen bottle shall be used. The employee shall be allowed to select one of the unoponed collection containers and/or specimen bottles that ~aro available at the site. The container (s) shall be unwrapped in the presgnco of the e_mployeu immediately prior to being provided. The container shall also be designed to record the temperature of the urino, if the specimen temperature is outsido the acceptablo range, the employee may volunteer to have his or her oral temperature taken to provido evidence to counter the reason to believe the specimen was altered or substituted. (Difference of less than 1.8 degrees F.
between body temperature and specimen is acceptable.)
- 13) If there is reason to suspect that a specimon has been tampered with, the employee will be asked to re submit a specimen and both specimens will be sont to the laboratory. The second specimen shall La obtained under the direct observation of a collection sito person of the same gender. The collection sito person's supervisor shall concur in advance with any decision to obtain a specimen under direct observation.
- 14) If collection site person determinos that specimen is not at toast 60ml of urine, the employco shall be directed to drink fluids and, after a reasonabio timo, try again. The emp!oyce may be asked to remain up to 8 hours9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br /> to provido thu specimen. After 8 hours9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br />, the Medical Review Officer shall refer the individual for medical ovaluation to determine whether the inability of the employoo is O
genuine or constitutes a refusal. The Medical Review Officer shall report written results to the employco's management.
- 15) After the specimen has been provioed. the employco will be allowed to wash his or her hands.
- 16) Chair of custody procedures will be followed. The employou and the collection sito person shall keep the specimen in view at all times until it is sealed, labeled, signed by-the employee, dated, identified with the employee's specimen number and logged by the collection sito person. The collection sito person then completos the urine custody and control (chain of custody) form which must accompany the specimen.
- 17) If the employeo refusos to cooperate with the collection process, the collection sito person shall inform the employco's supervision before allowing the employeo to leave the facility and shall document the non-cooperation on the urino custody and control form.
- 18) Utilizing proper chain of custody procedures, including a tamper proof sealing system and identifying the specimon container with the same number as -
printed on the urino custody and control form, the specimen will be transported in a scaled shipping containcr by laboratory courier from the collection site to the_ certified laboratory or a representativo of the certified laboratory. On the tape sealing the shipping container, the collection sito person shall sign and enter the dato rpocimen was sealed in the container. The collection sito-person shall ensure appropriato safoguarding during temporary storage.
O 40-25 Rev.9 i
.a-
]
B.
Results.
h
- 1) The laboratory shall report all results to the Medical Review Othcer. Results will be received on a single, secured printer located within tho Medical Department. A hard copy of the results will be sent to the Medical Review Officer through the mail.
- 2) Only results that have been confirmed positive using gas chromatography /rnass spectrornetry (GC/MS) shall be reported by the laboratory to the Medical Review Officer as positive.
- 3) The Medical Review Officer reviews and interprets confirmed positive test results received from the laboratory and examines alternate medical explanations. This action may include conducting a medit al interview and review of any other relevant biomedical factors,
- 4) Prior to rnaking a tinal decision to verify a positive test result, the Medical Review Officer contacts the employee directly, on a confidential basis, to provide employee an opportumty to discuss the lost results.
- 5) If, atter making all reasonable, documented efforts, the Medk al Review Officer is unable to reach the employee directly, the Medical Review Officer shall contact the employee's supervisor who shall direct the employee to contact the Medical Review Officer as soon as possible. The supervisor shall ensure that such contact is held in strict confidence.
6)
If, after making all reasonable efforts, the supervisor is unable to contact the employee, the employee may be suspended pending further investi0ation.
- 7) The Medical Review Officer may verity a test as positive without having g
communicated directly with the employee about the test if:
W a) The employee expressly declines the opportunity to discuss the test; or b) The employee's supervisor has successfully made and documented a contact with the employee and instructed the employee to contact the Medical Review Officer and more than 5 days have passed.
i.
The employee may present to the Medical Review Otticer information documenting that serious injury or illness or other cucumstances unavoidable prevented timely contact with the Medical Review Officer.
ii. On the basis of such information, the Medical Review Officer may reopen the verification,
- 8) If the Medical Review Officer determines that there is a legitimate medical explanation for the positive test resul' the Medical Review Officer shall report the test result to management as negative.
- 9) Should any question arise as to the accuracy or the valioity of the laboratory test results, only the Medical Review officer is authorized to order a re analysis of the original specimen and such re analysis is authorized only at a laboratory certified by DHHS.
40.12.8 Split Specirnens A.
Upon arrival at the collection site, an employee may request that a split specimen be collected. The cornpany will require the employee to pay for the cost of collection and shipment of the second specimen. Such payment shall be made by 4420 Rev _9
(
check or money order and shall be received by the company within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> of I
making the request.
O B.
All of the collection procedures listed in 40.12.7.A. will be followed.
C.
The employee shall urinate into a collection container which the collection site person, in the presence of the empiyee, after determining specimen temperature, pours into two specimen bottles. The first bottle (60ml) will be used for the primary test. If the employee cannot provide the required volume for both specimens (120ml), the first specimen bottle shall nevertheless be processed for testing.
D.
A copy of the chain of custody form will accompany each bottle to the laboratory.
The second spechnen will be stored by the laboratory in a secured. refrigerated environment and an appropriate entry made on the chain of custody form.
E.
If the first specimen tests positive, the employee may request that the Medical Review Officer direct that the second specimen be tested in a DHHS cettified laboratory for the presence of the drug (s) for which the positive result was obtained. The request for the second specimen to be tested must he submitted to the Medical Review Officer within 72 hours8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br /> of the employee's having actual notice that he or she tested positive. The Medical Review Officer will not direct the laboratory to test the second specimen without having received payment from the employee for the cost of collection, shipment and analysis.
F.
The result of the test of the second specimen is transmitted to the Medical Review Officer without regard to the cut-off values in 40.12.6.A.
G. The employee's removal from performing a safety-sensitive function is not stayed pending the results of the second test.
O H.
If the result of the second test is negative, the Med! cal Review Officer shall consider the results of both tests as neDative and the employee will be reimbursed for the expense.
40.12.9 Re analysis of Original Specimen If the Medical Review Officer determines there is no legitimate medical explanation for a confirmed positive test result other than the unauthorized use of a prohibited drug, the original specimen must be retested if the employee rnakes a wntten request for retestin0 within 60 days of receipt of the final test result from the Medical Review Officer. Only the Medical Review Officer is authorized to order a re analysis of the original specimen. The employee may specify retesting by the original laboratory or by a second laboratory that is certified by the DHHS. The company may require the empicyee to pay in advance the cost of the shipment (if any) and re-analysis of the specirnen, but the employee will be reimbursed for such expense if the retest is negative.
40.12.10 Follow up Screening A. 11 an employee who has tested positive for drugs is allowed to return to work following a rehabihtation program, the re-entry agreement shall require the ernployee to undergo unannounced follow-up dru0 screening according to the following schedule:
O
- 1) Twelve (12) times in the first twelve (12) months following the employee's return to work.
l 40-27 Rev.9
- . g,,.
,t
- 2) Once per quarter during the second and third twelve (12) Inonth periods.
- 3) Once during the fourth and fifth twelvo (12) month periods.
g D.
Ernployees in follow-up screening will also bo subject to ratectn screening if they are employed in positions designated for randorn screening.
C.
An employee who tests positive while undergoing follow up screening is in violation of the fitness for duty policy.
D.
Except at fort St. Vrain, if an employee who has tested postive for alcohol is allowed to return to work following a rehabilitation program, the re entty agreement shall not require follow up screening, but shall rely on perfortnance indicators. At Fort St. Vrain, follow-up alcohol screening will be required.
O O
40-28 Rev 9
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E Cll06 Zh oto - o f Rev.9 40-29
Public PUBUC SERVICE COMPANY OF COLORADO ATT ACHfAENT 400 Service' FITNESS FOR DUTY CHECKLIST O
This checklist is an a'd for management when an employee appears unfit for duty and the employee's job pertormance or i
behaviot suggests he/she is using drugs or is under the influence of alcohol. For example, an employeo exhibits uncharacteristic behavior or impaired judgement.
Procedural Steps Date T ime __. _..
I believe.__
is unfit for duty because:
O T he employee was involved in an on the job accident U Blank stare O Unsteady walk O Incoherent O Liquor on breath O Slurred speech C Odor of marijuana O Hed and/or glassy eyes O orowsiness O uncharacteristic giggle O Dilated pupits O Other uncharacteristic behavior, (list, be specific).
O Another member of management, has O confirmed my evaluation of the employee or has O witnessed the employee's behavior and concurs with my observations.
Name of other witness (s):
O Confronted employee, explained why I was concerned he/t.be may not be fit for duty. Asked employee what might be cause of problem (Record explanation)
O Explanation was unsatisf actory. I ordered employee to be tested for alcohol / drugs and indicated that refusal is an act of insubordination and employee will be subject to discharge.
O Employee was taken to collection site and was not allowed to drive. (if employee refuses test, repeat order to take the test and consequences of noncompliance).
O Assured that the employee was taken home. Iindicated he/she would be informed of the test results. I indicated the employee would be on suspension pending further investigation until the results of the test were received Print Name Title Signature FoRNi M4 fA 6v.A 4} 31 ReV 9
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