Page 421 - 2024 Orientation Manual

ALCOHOL AND DRUG SCREEN POLICY AND ACKNOWLEDGMENT

To ensure a safe and productive work environment at the LSBA, to safeguard property of the LSBA
and its personnel, LSBA strictly prohibits the use, possession or transfer of illegal drugs, drug
paraphernalia or alcohol on any LSBA property or while on LSBA business.

I, ______________________________, hereby give the LSBA my permission to test me for the
presence of alcohol or illegal drugs or narcotics based on a conditional job offer and/or at any time
while I am employed by the LSBA. I agree to cooperate in any such test knowing that the use of
alcohol or illegal drugs as mentioned above while I am on LSBA business and/or LSBA property as set
forth in the LSBA Employee Handbook’s policy statements is inconsistent with my health and safety,
as well as that of my fellow workers. I understand that if I have a detectable level of an illegal drug or
substance or alcohol in my system while on LSBA business or while on LSBA property, I will be in
violation of the LSBA’s policy and subject to the disciplinary action set forth below.

The LSBA will require all applicants for employment who receive conditional job offers to submit to
tests for the presence of alcohol and/or illegal drugs as a precondition of employment. The LSBA also
requires any Employee to submit to tests screening for the presence of alcohol and/or illegal drugs in
the following circumstances:

(1) following an accident or injury occurring during the course and scope of
employment; and,
(2) whenever there is reasonable suspicion to believe that an employee is using
illegal drugs or alcohol in violation of the LSBA’s policy.

I understand that by signing this document I consent to be tested for alcohol and illegal drugs, and that
if I refuse to be tested, I will either not be hired, or I will be terminated. I understand that if detectable
levels of an illegal drug or substance or alcohol are found in my system, this will be grounds for
revocation of my conditional job offer, or the immediate termination of my employment.

I acknowledge that I have been notified of the LSBA’s intent to test for the presence of illegal drugs
and/or alcohol in my body and by my signature below, I consent to same. I further acknowledge that I
have been advised that I may make a written request for a complete and accurate disclosure of the
nature and scope of the tests conducted. I also understand and have been advised that I should not rely
on any attempted oral modifications or amendments of the policy and that the only modifications or
amendments which are binding are those which are in writing and authorized by the Executive
Director of the LSBA.

_________________________________________ ________________________
Employee Date

_________________________________________ ________________________
Witness Date

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