403 EMPLOYEES' HEALTH AND WELL-BEING

403.1 EMPLOYEE PHYSICAL EXAMINATIONS

The Tipton Community School believes good health is important to job performance. School bus drivers will present evidence of good health upon initial hire and every other year in the form of a physical examination report, unless otherwise required by law or medical opinion. All other employees shall present evidence of good health, in the form of a post-offer examination if determined necessary by the superintendent of schools or designee.

The cost of the initial examination will be paid by the Tipton Community School District. . The form indicating the employee is able to perform the duties, with or without reasonable accommodation, for which the employee was hired, must be returned prior to the performance of duties. The cost of bus driver renewal physicals will be paid by the school district at 100% if the driver utilizes the district designated physician or district designated certified medical examiner for bus drivers.  The driver will be reimbursed up to the cost charged by the district designated physician or certified medical examiner if the driver chooses to use a non-designated physician or examiner. The school district will provide the standard examination form to be completed by the personal physician of the employee or a certified medical examiner for bus drivers. 

Employees whose physical or mental health, in the judgment of the administration, may be in doubt will submit to additional examinations to the extent job-related and consistent with business necessity, when requested to do so, at the expense of the school district.

The district will comply with occupational safety and health requirements as applicable to its employees in accordance with law.

 

 

 

Legal Reference:         

     29 C.F.R. § 1910.1030.

     49 C.F.R. §§ 391.41 – 391.49.

     Iowa Code §§ 20.9; 279.8; 321.376.

      281 I.A.C. 43.15; 43.17.

 

Cross Reference:         

     403      Employees' Health and Well-Being

 

 

Approved:        12/9/1996                                                              Reviewed:    11/14/2022                               Revised:       6/12/2017            

403.2 EMPLOYEE INJURY ON THE JOB

When an employee becomes seriously injured on the job, the building principal will attempt to notify a member of the family, or an individual of close relationship, as soon as the building principal becomes aware of the injury.

If possible, an employee may administer emergency or minor first aid.  An injured employee will be turned over to the care of the employee's family or qualified medical employees as quickly as possible.  The school district is not responsible for medical treatment of an injured employee.

It is the responsibility of the employee injured on the job to inform the superintendent within twenty-four hours of the occurrence.  It is the responsibility of the employee's immediate supervisor to file an accident report within twenty-four hours after the employee reported the injury.

It is the responsibility of the board secretary to file worker's comp claims.

 

 

 

Legal Reference:      

     Iowa Code §§ 85; 279.40; 613.17 .

  

Cross Reference:      

     409.2  Licensed Employee Personal Illness Leave

Approved:         12/9/1996                                                        Reviewed:   11/14/2022                                                    Revised:  11/14/2022

403.3 COMMUNICABLE DISEASES - EMPLOYEES

Employees with a communicable disease will be allowed to perform their customary employment duties provided they are able to perform the essential functions of their position and their presence does not create a substantial risk of illness or transmission to students or other employees.  The term "communicable disease" will mean an infectious or contagious disease spread from person to person, or animal to person, or as defined by law.

 

Prevention and control of communicable diseases shall be included in the school district's bloodborne pathogens exposure control plan.  The procedures will include scope and application, definitions, exposure control, methods of compliance, universal precautions, vaccination, post-exposure evaluation, follow-up, communication of hazards to employees and record keeping.  This plan is reviewed annually by the superintendent and school nurse.

 

The health risk to immunodepressed employees is determined by their personal physician. The health risk to others in the school district environment from the presence of an employee with a communicable disease shall be determined on a case-by-case basis by the employee's personal physician, a physician chosen by the school district or public health officials.

Health data of an employee is confidential and it will not be disclosed to third parties. Employee medical records are kept in a file separate from their personal file.

 

It is the responsibility of the superintendent, in conjunction with the school nurse, to develop administrative regulations stating the procedures for dealing with employees with a communicable disease.

 

 

Legal Reference:      

        29 U.S.C. §§ 794, 1910.

        42 U.S.C. §§ 12101 et seq.

        45 C.F.R. Pt. 84.3

        Iowa Code  § 139A; 141A.

        641 I.A.C. 1.2-.7.

Cross Reference:

     401.5  Employee Records

     401.5R1 Employee Records - Regulation

     403.1  Employee Physical Examinations

     507.3  Communicable Diseases - Students

     907     District Operation During Public Emergencies

     907.R1  District Operation During Public Emergencies - Regulation

 

 

Approved:   12/9/1996                  Reviewed:  11/14/2022                   Revised:  11/14/2022

 

403.3E1 HEPATITIS B VACCINE INFORMATION AND RECORD

The Disease

Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV) which causes death in 1-2% of those infected.  Most people with HBV recover completely, but approximately 5-10% become chronic carriers of the virus.  Most of these people have no symptoms, but can continue to transmit the disease to others.  Some may develop chronic active hepatitis and cirrhosis.  HBV may be a causative factor in the development of liver cancer.  Immunization against HBV can prevent acute hepatitis and its complications.

The Vaccine

The HBV vaccine is produced from yeast cells.  It has been extensively tested for safety and effectiveness in large scale clinical trials.

Approximately 90 percent of healthy people who receive two doses of the vaccine and a third dose as a booster achieve high levels of surface antibody (anti-HBs) and protection against the virus.  The HBV vaccine is recommended for workers with potential for contact with blood or body fluids.  Full immunization requires three doses of the vaccine over a six-month period, although some persons may not develop immunity even after three doses.

There is no evidence that the vaccine has ever caused Hepatitis B.  However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical hepatitis in spite of immunization.

Dosage and Administration

The vaccine is given in three intramuscular doses in the deltoid muscle.  Two initial doses are given one month apart and the third dose is given six months after the first.

Possible Vaccine Side Effects

The incidence of side effects is very low.  No serious side effects have been reported with the vaccine.  Ten to 20 percent of persons experience tenderness and redness at the site of injection and low grade fever.  Rash, nausea, joint pain, and mild fatigue have also been reported.  The possibility exists that other side effects may be identified with more extensive use.

 

HEPATITIS B VACCINE INFORMATION AND RECORD CONSENT OF HEPATITIS B VACCINATION

I have knowledge of Hepatitis B and the Hepatitis B vaccination.  I have had an opportunity to ask questions of a qualified nurse or physician and understand the benefits and risks of Hepatitis B vaccination.  I understand that I must have three doses of the vaccine to obtain immunity. However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience side effects from the vaccine.  I give my consent to be vaccinated for Hepatitis B.

 

 

Signature of Employee (consent for Hepatitis B vaccination)                               Date

 

 

Signature of Witness                                                                                           Date

 

 

REFUSAL OF HEPATITIS B VACCINATION

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus infection.  I have been given the opportunity to be vaccinated with Hepatitis B vaccine at no charge to myself.  However, I decline the Hepatitis B vaccination at this time.  I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.  If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

 

 

Signature of Employee (refusal for Hepatitis B vaccination)                                 Date

 

 

Signature of Witness                                                                                           Date

 

I refuse because I believe I have (check one)

 

    ______       started the series                        ______      completed the series

 

 

HEPATITIS B VACCINE INFORMATION AND RECORD RELEASE FORM FOR HEPATITIS B MEDICAL INFORMATION

I hereby authorize                                                                                          (individual or organization holding Hepatitis B records and address) to release to the Tipton Community School District, my Hepatitis B vaccination records for required employee records.

 

I hereby authorize release of my Hepatitis B status to a health care provider, in the event of an exposure incident.

 

 

Signature of Employee                                                                                             Date                                                 

 

 

Signature of Witness                                                                                                       Date                                             

 

 

HEPATITIS B VACCINE INFORMATION AND RECORD CONFIDENTIAL RECORD

Employee Name (last, first, middle)                                           Social Security No. Job Title:                                                                                              

 

 

Hepatitis B Vaccination Date

Lot Number

Site

Administered by

1

                                               

 

 

 

2

                                               

 

 

 

3

                                               

 

 

 

 

Additional Hepatitis B status information:

Post-exposure incident: (Date, time, circumstances, route under which exposure occurred) Identification and documentation of source individual:

 

Identification and documentation of source individual:

 

Source blood testing consent:

 

 

 

Description of employee's duties as related to the exposure incident:

 

 

Copy of information provided to health care professional evaluating an employee after an exposure incident:

 

 

Attach a copy of all results of examinations, medical testing, follow-up procedures, and health care professional's written opinion.

 

Training Record: (date, time, instructor, location of training summary)

 

Cross References:

     401.5  Employee Records

     401.5R1  Employee Records - Regulation

      403.1  Employee Physical Examinations

      507.3  Communicable Diseases - Students

      907    District Operation During Public Emergencies

      907.R1  District Operation During Public Emergencies - Regulation

 

Approved:   12/9/1996                                          Reviewed:  11/14/2022                                      Revised:  11/14/2022

403.3R1 UNIVERSAL PRECAUTIONS REGULATION

Universal precautions (UP) are intended to prevent transmission of infection, as well as decrease the risk of exposure for employees and students.  It is not currently possible to identify all infected individuals, thus precautions must be used with every individual.  UP pertain to blood and other potentially infectious materials (OPIM) containing blood.  These precautions do not apply to other body fluids and wastes (OBFW) such as saliva, sputum, feces, tears, nasal secretions, vomitus and urine unless blood is visible in the material.  However, these OBFW can be sources of other infections and should be handled as if they are infectious.  The single most important step in preventing exposure to and transmission of any infection is anticipating potential contact with infectious materials in routine as well as emergency situations.  Based on the type of possible contact, employees and students should be prepared to use the

appropriate precautions prior to the contact.  Diligent and proper hand washing, the use of barriers, appropriate disposal of waste products and needles, and proper decontamination of spills are essential techniques of infection control.  All individuals should respond to situations practicing UP followed by the activation of the school response team plan.  Using common sense in the application of these measures will enhance protection of employees and students.

 

Hand Washing

Proper hand washing is crucial to preventing the spread of infection.  Textured jewelry on the hands or wrists should be removed prior to washing and kept off until completion of the procedure and the hands are rewashed.  Use of running water, lathering with soap and using friction to clean all hand surfaces is key.  Rinse well with running water and dry hands with paper towels.

  • Hands should be washed before physical contact with individuals and after contact is completed.
  • Hands should be washed after contact with any used equipment.
  • If hands (or other skin) come into contact with blood or body fluids, hands should be washed immediately before touching anything else.
  • Hands should be washed whether gloves are worn or not and, if gloves are worn, after the gloves are removed.

 

Barriers

Barriers anticipated to be used at school include disposable gloves, absorbent materials and resuscitation devices.  Their use is intended to reduce the risk of contact with blood and body fluids as well as to control the spread of infectious agents from individual to individual.  Gloves should be worn when in contact with blood, OPIM or OBFW.  Gloves should be removed without touching the outside and disposed of after each use.

Disposal of Waste

Blood, OPIM, OBFW, used gloves, barriers and absorbent materials should be placed in a plastic bag and disposed of in the usual procedure.  When the blood or OPIM is liquid, semi-liquid or caked with dried blood, it is not absorbed in materials, and is capable of releasing the substance if compressed, special disposal as regulated waste is required.  A band-aid, towel, sanitary

napkin or other absorbed waste that does not have the potential of releasing the waste if compressed would not be considered regulated waste.  It is anticipated schools would only have regulated waste in the case of a severe incident.  Needles, syringes and other sharp disposable objects should be placed in special puncture-proof containers and disposed of as regulated waste.  Bodily wastes such as urine, vomitus or feces should be disposed of in the sanitary sewer system.

Clean up

Spills of blood and OPIM should be cleaned up immediately.  The employee should:

  • Wear gloves.
  • Clean up the spill with paper towels or other absorbent material.
  • Use a solution of one part household bleach to one hundred parts of water (1:100) or other EPA-approved disinfectant and use it to wash the area well.
  • Dispose of gloves, soiled towels and other waste in a plastic bag.
  • Clean and disinfect reusable supplies and equipment.

Laundry

Laundry with blood or OPIM should be handled as little as possible with a minimum of agitation. It should be bagged at the location.  If it has the potential of releasing the substance when compacted, regulated waste guidelines should be followed.  Employees who have contact with this laundry should wear protective barriers.

Exposure

An exposure to blood or OPIM through contact with broken skin, mucous membrane or by needle or sharp stick requires immediate washing, reporting and follow-up.

  • Always wash the exposed area immediately with soap and water.
  • •If a mucous membrane splash (eye or mouth) or exposure of broken skin occurs, irrigate or wash the area thoroughly.
  • •If a cut or needle stick injury occurs, wash the area thoroughly with soap and water.

The exposure should be reported immediately, the parent or guardian is notified, and the person exposed contacts a physician for further health care.

Cross Reference:

     401.5 Employee Records

     401.5R1 Employee Records - Regulation

     403.1 Employee Physical Examinations

     507.3 Communicable Diseases - Students

     907 District Operation During Public Emergencies

     907-R1 District Operation During Public Emergencies - Regulation

 

Approved:   12/9/1996                                                              Reviewed:   11/14/2022                                          Revised:  12/8/2014

403.4 HAZARDOUS CHEMICAL DISCLOSURE

The board authorizes the development of a comprehensive hazardous chemical communication program for the school district to disseminate information about hazardous chemicals in the workplace.

Each employee will annually review information about hazardous substances in the workplace. When a new employee is hired or transferred to a new position or work site, the information and training, if necessary, shall be included in the employee's orientation.  When an additional hazardous substance enters the workplace, information about it is distributed to all employees, and training is conducted for the appropriate employees.  The superintendent will maintain a file indicating when which hazardous substances are present in the workplace and when training and information sessions take place.

Employees who will be instructing or otherwise working with students will disseminate information about the hazardous chemicals with which they will be working as part of the instructional program.

It is the responsibility of the superintendent to develop administrative regulations regarding this program.

 

 

Legal Reference:      

     29 C.F.R. Pt. 1910; 1200 et seq. 

     Iowa Code chs. 88; 89B.

    

Cross Reference:

      804.4 Asbestos Containing Material

Approved:   12/9/1996                                                     Reviewed:  11/14/2022                                                           Revised: 11/14/2022

403.5 SUBSTANCE-FREE WORKPLACE

The board expects the school district and its employees to remain substance free.  No employee shall unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of, in the workplace, any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana or any other controlled substance or alcoholic beverage as defined by federal or state law. "Workplace" includes school district facilities, school district premises or school district vehicles, also includes nonschool property if the employee is at any school-sponsored, school-approved or school-related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school business.

If an employee is convicted of a violation of any criminal drug offense committed in the workplace, the employee will notify the employee's supervisor of the conviction within five days of the conviction.

The superintendent will make the determination whether to require the employee to undergo substance abuse treatment or to discipline the employee. An employee who violates the terms of this policy may be subject to discipline up to and including termination. An employee who violates this policy may be required to successfully participate in a substance abuse treatment program approved by the board.  If the employee fails to successfully participate in a program, the employee may be subject to discipline up to and including termination.

The superintendent is responsible for publication and dissemination of this policy to each employee.  In addition, the superintendent will oversee the establishment of a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment programs.

It is the responsibility of the superintendent to develop administrative regulations to implement this policy.

 

Legal Reference:      

     41 U.S.C. §§ 701-707 (1988). 81

     42 U.S.C. §§ 12101 et seq. (Supp. 1990).

     34 C.F.R. Pt. 85 (1993).

     Iowa Code §§ 123.46; 124; 279.8.

 

Cross Reference:      

     403.6  Drug and Alcohol Testing Program

     406.6E1  Drug and Alcohol Testing Program - Notice to Employees

     406.6E2  Drug and Alcohol Testing Program - Pre-Employment Testing Acknowledgment Form

     403.6E3  Drug and Alcohol Testing Program - Written Consent to Share Information     

     404  Employee Conduct and Appearance

     404-R1  Employee Conduct and Appearance - Code of Professional Conduct and Ethics Regulation

     404-R2  Employee Conduct and Appearance - Code of Rights and Responsibilities    Regulation

 

Approved:    12/9/1996                                                                      Reviewed:        11/14/2022                                    Revised:  11/14/2022

403.5E1 SUBSTANCE-FREE WORKPLACE NOTICE TO EMPLOYEES

EMPLOYEES ARE HEREBY NOTIFIED it is a violation of the Substance-Free Workplace policy for an employee to unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana or any other controlled substance or alcohol, as defined in Schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation at 21 C.F.R. 1300.11 through 1300.15 and Iowa Code Chapter 204.

"Workplace" is defined as the site for the performance of work done in the capacity as an employee.  This includes school district facilities, other school premises or school district vehicles.  Workplace also includes nonschool property if the employee is at any school-sponsored, school-approved or school-related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school business.

Employees who violate the terms of the Substance-Free Workplace policy may be required to successfully participate in a substance abuse treatment program approved by the board. The superintendent retains the discretion to discipline an employee for violation of the Substance-Free Workplace policy.  If the employee fails to successfully participate in such a program the employee shall be subject to discipline up to and including termination.

EMPLOYEES ARE FURTHER NOTIFIED it is a condition of their continued employment that they comply with the above policy of the school district and will notify their supervisor of their conviction of any criminal drug statute for a violation committed in the workplace, no later than five days after the conviction.

 

SUBSTANCE-FREE WORKPLACE ACKNOWLEDGMENT FORM

 

I, _______________________ , have read and understand the Substance-Free Workplace policy.  I understand that if I violate the Substance-Free Workplace policy, I may be subject to discipline up to and including termination or I may be required to participate in a substance abuse treatment program.  If I fail to successfully participate in a substance abuse treatment program, I understand I may be subject to discipline up to and including termination.  I understand that if I am required to participate in a substance abuse treatment program and I refuse to participate, I may be subject to discipline up to and including termination.  I also understand that if I am convicted of a criminal drug offense committed in the workplace, I must report that conviction to my supervisor within five days of the conviction.

 

 

___________________________________(Signature of Employee)                              _______________ (Date)                    

Approved:   12/9/1996                                Reviewed:  11/14/2022                                                  Revised:  11/14/2022

 

403.5R1 SUBSTANCE-FREE WORKPLACE REGULATION

A superintendent who suspects an employee has a substance abuse problem will follow these procedures:

  1. Identification - the superintendent will document the evidence the superintendent has which leads the superintendent to conclude the employee has violated the Substance-Free Workplace policy.  After the superintendent has determined there has been a violation of the Substance-Free Workplace policy, the superintendent will discuss the problem with the employee.

  2. Discipline - if, after the discussion with the employee, the superintendent determines there has been a violation of the Substance-Free Workplace policy, the superintendent may recommend discipline up to and including termination or may recommend the employee seek substance abuse treatment.  Participation in a substance abuse treatment program is voluntary.

  3. Failure to participate in referral - if the employee refuses to participate in a substance abuse treatment program or if the employee does not successfully complete a substance abuse treatment program, the employee may be subject to discipline up to and including termination.

  4. Conviction - if an employee is convicted of a criminal drug offense committed in the workplace, the employee must notify the employer of the conviction within five days of the conviction.

 

Approved:  12/9/1996                          Reviewed:  11/14/2022                                       Revised: 11/14/2022

403.6 DRUG AND ALCOHOL TESTING PROGRAM

Employees who operate school vehicles are subject to drug and alcohol testing if a commercial driver's license is required to operate the school vehicle and the school vehicle transports sixteen or more persons including the driver or the school vehicle weighs twenty-six thousand one pounds or more.  For purposes of the drug and alcohol testing program, the term "employees" includes applicants who have been offered a position to operate a school vehicle. 

The employees operating a school vehicle as described above are subject to pre-employment drug testing and random, reasonable suspicion, and post-accident, drug and alcohol testing.  Employees operating school vehicles will not perform a safety-sensitive function within eight hours of using alcoholEmployees governed by this policy are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate school vehicles and continue to be subject to the drug and alcohol testing program as long as they may be required to perform a safety-sensitive function as defined in the administrative regulations.  Employees with questions about the drug and alcohol testing program may contact the transportation director at 400 E. 6th St., Tipton, IA.   

Employees who violate the terms of this policy are subject to discipline up to and including termination.  The district is required to keep a record of all drug or alcohol violations by employees for a minimum of five years.  Employees are put on notice that information related to drug or alcohol violations will be reported to the Federal Motor Carrier Safety Administration (FMCSA) Clearinghouse.  Additionally, the district will conduct FMCSA Clearinghouse queries for employees annually.  Employees must provide written consent for the district to conduct FMCSA Clearinghouse queries; however, employees who choose to withhold consent will be prohibited from performing any safety-sensitive functions. It is the responsibility of the superintendent to develop administrative regulations to implement this policy in compliance with the law.  The superintendent will inform applicants of the requirement for drug and alcohol testing in notices or advertisements for employment. 

The superintendent will also be responsible for publication and dissemination of this policy and supporting administrative regulations and forms to employees operating school vehicles.  The superintendent will also oversee a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment resources and programs.

 

IASB Drug and Alcohol Testing Program (IDATP) Web site:  

https://www.ia-sb.org/Main/Affiliated_Programs/Iowa_Drug_Alcohol_Testing_Program.aspx

 

 

Legal Reference:      

     American Trucking Association, Inc., v. Federal Highway Administration, 51 Fed. 3rd   

     405 Cir. (4th 1995).

     42 U.S.C. §§ 5331 et seq.

     42 U.S.C. §§ 12101

     41  U.S.C. §§ 81.

     49 C.F.R. Pt. 40; 382; 

     34 C.F.R. Pt. 85 

     Local 301, Internat'l Assoc. of Fire Fighters, AFL-CIO, and City of

     Burlington, PERB No. 3876 (3-26-91). 

     Iowa Code §§ 124; 279.8; 321.375(2); 730.5

Cross Reference:

     403.5       Substance-Free Workplace

     403.5R1   Substance-Free Workplace - Regulation

     403.5E1   Substance-Free Workplace - Notice to Employees

     409.2  Employee Leaves of Absence 

 

 

 

Approved:  12/9/96                                                          Reviewed:         11/14/2022                                                   Revised:  11/14/2022   

 

403.6E1 DRUG AND ALCOHOL TESTING PROGRAM-NOTICE TO EMPLOYEES

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE HEREBY NOTIFIED they are subject to the school district's drug and alcohol testing program for pre-employment drug testing and random, reasonable suspicion, post-accident, return-to-duty and follow-up drug and alcohol testing as outlined in the Drug and Alcohol Testing Program policy, its supporting documents and the law. 

Employees who operate school vehicles are subject to drug and alcohol testing if a commercial driver's license is required to operate the school vehicle and the school vehicle transports sixteen or more persons including the driver or the school vehicle weighs twenty-six thousand, one pounds or more.  For purposes of the drug and alcohol testing program, "employees" also includes applicants who have been offered a position to operate a school vehicle.  The employees operating a school vehicle are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate a school vehicle and continue to be subject to the drug and alcohol testing program. 

It is the responsibility of the superintendent to inform employees of the drug and alcohol testing program requirements.  Employees with questions regarding the drug and alcohol testing requirements will contact the school district contact person

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that employees violating this policy, its supporting documents or the law may be subject to discipline up to and including termination.  As a condition of continued employment, employees violating this policy, its supporting documents or the law bear the personal and financial responsibility, as a condition of continued employment, to successfully participate in a substance abuse evaluation and a substance abuse treatment program recommended by the substance abuse professional. Employees required to participate in and who fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program may be subject to discipline up to and including termination.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that information related to drug or alcohol violations will be reported the the Federal Motor Carrier Safety Administration (FMCSA) Clearinghouse. 

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED it is a condition of their continued employment to comply with the Drug and Alcohol Testing Program policy, its supporting administrative documents and the law.  It is a condition of continued employment for employees operating a school vehicle to notify their supervisor of any prescription medication they are using.  Drug and alcohol testing records about a driver are confidential and are released in accordance with this policy, its supporting documents or the law.

 Cross References:

     403.5    Substance-Free Workplace

     403.5R1    Substance-Free Workplace Regulation

     403.5E1    Substance-Free Workplace - Notice to Employees

     409.2    Employee Leave of Absence

 

Approved:  12/9/1996                                                            Reviewed   11/14/2022                                   Revised:  11/14/2022

 

403.6-E2 DRUG AND ALCOHOL TESTING PROGRAM ACKNOWLEDGMENT FORM

I, ___________________(name of employee), have received a copy, read and understand the Drug and Alcohol Testing Program policy of the Tipton Community School District and its supporting documents 

I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents or the law, I may be subject to discipline up to and including termination or I may be required to successfully participate in a substance abuse evaluation and a substance abuse treatment program if recommended by the substance abuse professional.  If I am required to and fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program, I understand I may be subject to discipline up to and including termination.

I also understand that I must inform my supervisor of any prescription medication I use.

In addition, I have received a copy of the U.S. DOT publication, “What Employees Need to Know about DOT Drug & Alcohol Testing,” and have read and understood its contents.

Furthermore, I know and understand that I am required to submit to a controlled substance (drug) test, the results of which must be received by this employer before being employed by the school district and before being allowed to perform a safety-sensitive function.  I also understand that if the results of the pre-employment test are positive, that I will not be considered further for employment with the school district. 

I further understand that drug and alcohol testing records and information about me are confidential and may be released at my request or in accordance with the district’s drug and alcohol testing program policy, its supporting documents or the law.

  __________________________                                         ______________________

 (Signature of Employee)                                                           (Date)

 Cross References:

     403.5     Substance-Free Workplace

     403.5R1    Substance-Free Workplace - Regulation

     403.5E1    Substance-Free Workplace - Notice to Employees

      409.2    Employees Leave of Absence

 

 

Approved:  12/9/1996               Reviewed: 11/14/2022                          Revised: 11/14/2022  

 

403.6-E3 DRUG AND ALCOHOL TESTING PROGRAM - WRITTEN CONSENT TO SHARE INFORMATION

 

DRUG & ALCOHOL PROGRAM AND PRE-EMPLOYMENT TESTING

WRITTEN CONSENT TO SHARE INFORMATION

 

I, ________________________ , understand that as part of my employment in a position that requires a commercial driver’s license in the Tipton Community School

District, I grant consent for the District to conduct queries of the Federal Motor Carrier Safety Administration (“FMCSA”) Commercial Driver’s License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse.  I further consent to the District sharing information related to my drug and alcohol testing results with prior, current and future employers, as well as the FMCSA Clearinghouse in accordance with state and federal laws. 

 

I understand that the District will check and perform queries of my drug and alcohol testing results prior to my employment in any position which requires the use of a commercial driver’s license.  I further understand the District will check and perform queries of my testing results annually and is required to report any drug and alcohol violations of this policy to the FMCSA Clearinghouse. 

 

I understand that I am not required to consent to the query of the FMCSA Clearinghouse or the District sharing of drug and alcohol testing information with past, present or future employers or the FMCSA Clearinghouse; but that without my consent I understand I will be prohibited from performing safety sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations. 

 

I hereby give my consent to the District to perform queries of the FMCSA Clearinghouse and share my drug and alcohol testing results with past, present and future employers, as well as the FMCSAClearinghouse.

 

__________________________________         _________________

(Signature of Employee)                                       (Date)

 

 Cross References:

     403.5    Substance-Free Workplace

     403.5R1    Substance-Free Workplace Regulation

     403.5E1    Substance-Free Workplace - Notice to Employees

     409.2    Employee Leave of Absence

 

Approved:  12/9/1996                            Reviewed:  11/14/2022                         Revised: 11/14/2022

403.6R1 SUBSTANCE-FREE WORKPLACE REGULATION

A superintendent who suspects an employee has a substance abuse problem shall follow these procedures:

  1. Identification - the superintendent shall document the evidence the superintendent has which leads the superintendent to conclude the employee has violated the Substance-Free Workplace policy.  After the superintendent has determined there has been a violation of the Substance-Free Workplace policy, the superintendent shall discuss the problem with the employee.
  2. Discipline - if, after the discussion with the employee, the superintendent determines there has been a violation of the Substance-Free Workplace policy, the superintendent may recommend discipline up to and including termination or may recommend the employee seek substance abuse treatment.  Participation in a substance abuse treatment program is voluntary.
  3. Failure to participate in referral - if the employee refuses to participate in a substance abuse treatment program or if the employee does not successfully complete a substance abuse treatment program, the employee may be subject to discipline up to and including termination.
  4. Conviction - if an employee is convicted of a criminal drug offense committed in the workplace, the employee must notify the employer of the conviction within five days of the conviction.

 

 

 

 

 

 

 

Approved:   12/9/1996                                                     Reviewed:     09/12/2022                                     Revised:  12/8/2014