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

403.6E3

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 also understand it is required by law that Tipton Community School District must maintain a motor vehicle record for each driver in their Driver Qualification file. The school district must request each driver’s MVR every 12 months and must keep the record for 3 years. The school district must review the motor vehicle records of drivers it employs to determine whether that driver meets minimum requirements for safe driving or is disqualified to drive a CMV (per 391.15).

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

 

__________________________________         _________________

(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:  12/08/2025                        Revised: 12/08/2025

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