MV Transportation, Inc. CONTRACTOR FTA DRUG & ALCOHOL COMPLIANCE CHECKLEST

Transcription

1 MV Transportation, Inc. CONTRACTOR FTA DRUG & ALCOHOL COMPLIANCE CHECKLEST 1. Contractor Substance Abuse Program Manager/Designated Employer Representative (DER): : : FAX: 2. Total number of employees: at work location in company 3. Number of employees performing safety-sensitive work for MVT 4. Does your company perform DOT covered work for other companies? Please specify and describe. Administration Training 5. Has your Substance Abuse Program Manager, DER, or other Manager attended training on administering this program? 6. Please specify who, describe training, date, instructor, and sponsoring organization: Policy 7. Has MVT received a copy of your most recent policy? When: 8. Has your legal counsel reviewed and approved your policy? 9. Has your governing board approved your policy? (Please attach documentation of board approval.) MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 1

2 Policy Components REQUIRED POLICY COMPONENT YES/NO PAGE NO(S). Identity of contact person(s) for the program (DER) Categories of employees subject to testing Period of work day when covered employees must be in compliance and when they may be tested Prohibited behavior, including when regulations prohibited the use of alcohol and drugs Testing circumstances for drugs and alcohol (i.e. Preemployment, random, reasonable suspicion etc.) Testing procedures will be consistent with 49CFR Part 40 and that indicate where copy is available Behavior and circumstances that constitute a refusal to submit to a test, and statement that refusals constitute a verified positive Consequences for employee of verified positive test result. If a second chance is allowed, description of evaluation & treatment process. Consequences for employee with alcohol concentration > 0.02 but < 0.04 Information concerning the effects of alcohol misuse and methods of intervening. Clearly differentiated elements of a company anti-drug or alcohol misuse program that are in addition to FTA requirements Consortium/Third Party Administrators 10. If you are part of a consortium or have hired a contractor to provide all or part of the testing services for you please identify: Company: Manager: : : FAX: Please describe the consortium, (who is involved, who oversees). 13. Please describe the distribution of responsibilities; i.e. who is responsible for what functions. MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 2

3 14. Please describe the procedures for monitoring this contractor: Service Agents DHHS certified Lab: (Attach copy of DHHS certificate.) Medical Review Officer (MRO) (Attach copy of license and other qualifications.) Substance Abuse Professional (SAP) (Attach copy of license & other qualifications, including certification after 12/31/03.) MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 3

4 Test Collection & Analysis 15. Are you, or your C/TPA, performing blind sample tests? If yes, how are these performed? 16. Do you inspect your collection site facilities? How frequently? Date of last inspection 17. Do you monitor cancelled tests? Number during last year 18. With cancelled pre-employment and return-to-duty tests, do you recollect? 19. Reasons for cancelled tests: 20. What corrective measures have you taken to minimize the number of canceled tests? Alcohol Testing Equipment 21. Is alcohol testing contracted out? If yes, complete following: 21. Type of devise used (specify Make & Model #) 22. Are non-evidential testing devices being used? 23. Describe the procedures used for conducting alcohol testing: 24. Type and location of primary EBT: 25. Type and location of secondary EBT: 26. Provide list of certified Breath Alcohol Technicians (BAT) or Screen Test Technicians (STT): Date of Certification Date of Last Training MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 4

5 (Please attach a copy of the BAT/STT training certificate.) Random Selection Process 21. Please describe the random selection process: 22. Who selects the employees? Is a scientifically valid random-number selection method used? 23. How do you assure only USDOT safety-sensitive employees are in the random pool? 24. How often are selections made (Daily? Weekly? Monthly? Quarterly?) 25. How soon after selections are made are the tests performed? 26. If employees do not work at the time of selection, are they tested upon return to work? 27. Who notifies the employee of test requirement? 28. During what part of the employees shift are tests conducted? 29. Number of safety-sensitive employees: 30. Required number of tests needed to be preformed to meet FTA requirements for drug (50%) and alcohol testing (10%). MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 5

6 31. How do you assure that dates are spread throughout the calendar year and that tests are conducted at all times of day when safety-sensitive functions are performed? 32. How do you assure selected employees proceed immediately to the collection site? 33. Do you document the random number selection process as well as date and time of notification and collection? Post-Accident Testing 34. Have you established internal procedures to conduct testing any time individuals are performing safety-sensitive functions? 35. Have you trained and empowered supervisors or responsible employees to send employees when warranted? 36. Do you have a tool to assist in making the determination whether or not to test following an accident and do you document decisions not to test? 37. Do you monitor post-accident testing to assure FTA timeliness requirements are met or are appropriately documented? Record Keeping 38. Where are the drug and alcohol testing records stored? Are they kept separate from personnel records? MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 6

7 39. Who has access to these records? RECORD STORAGE DETAILS RECORD YES/NO WHO/WHERE Data on test results with BAC > 0.02 Employers copy of the alcohol test form Data on test refusals MRO reports of verified positive drug results Data on referrals to SAP SAP determination of need for assistance Employee compliance with SAP recommendations Records of RTC and follow-up testing Calibration documentation for EBT device Annual MIS report Records of training of employees Records of supervisor reasonable suspicion training Data of training of BAT s Collection process (including logbooks, if used) Data on post accident decisions to test, including accident reports MVT Contractor Drug & Alcohol Compliance Checklist - 09/03 7