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E <br />JOHNSON-DAVIS INC. <br />6D4 NILLBRATII DRIVE <br />LANTANA, FLORIDA 7346I-1694 <br />561.588-1170 FAX 561 -SOS -5257 <br />CU-CO43097 <br />DRUG FREE WORKPLACE CHECKLIST FOR JOB APPLICANTS <br />Name of Applicant: Date: <br />1. Give the applicant a copy of the Company's Drug Free Workplace Policy to read <br />along with a list of names, addresses and telephone numbers of employee assistance <br />programs and local drug rehabilitation programs (DF)3' 1). Proceed further only <br />after the -applicant has read the Policy. <br />2. Ask the applicant to read, initial and sign the Drug Free Workplace <br />Acknowledgement Form (DFW-2). <br />3. -Make an appointment for the job. applicant at the collection site for a drug.test. Have <br />the applicant complete an Authorization Form (D.MV 3), give the applicant the list of <br />over-the-counter and prescription drugs that could alter or affect the outcome of a <br />drug test (DF1,Y-4) and provide directions to the collection site. Advise the applicant <br />that a picture ID is required for a drug test. <br />4. if the drug test is negative: the applicant may report to work. Sign the form below <br />and place in personnel file. <br />5. If the drug test is positive with confirmation by (**NAME OF LAB DOING <br />TESTS**): the MRO should contact the applicant of the positive test result and the <br />employer should proceed as directed below. <br />6. Send a certified letter (DF)II-7) to the employee within five (5) days of receiving the <br />notice of a confirmed positive test result. DFJ+ 7 advises the applicant that he/she is <br />disqualified from further consideration. <br />7. If new information or a challenge is received from the applicant within five (5) <br />working days after the employee received a copy of positive test results, proceed to <br />number 9. <br />