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MODEL SUBSTANCE ABUSE POLICIES
Applicants Applicant (Point of Collection) Employee Model Appeal Form
APPLICANTS
A. COVERED ESTABLISHMENT
Company name: [Provide name, address, etc. of employer]
Street address:
Mailing address:
Phone:
Contact regarding substance abuse testing policy:
[Name & Title of Contact]
[Phone Number of Contact]
Location(s) Covered: [List Location(s) Covered]
This policy complies with the Maine Substance Abuse Testing Law (26 M.R.S.A. Sec. 681-690) and the Maine Department of Labor Rules relating to Substance Abuse Testing (adopted October 27, 1989).
Applicants will be notified at the time of initial application that they may be tested for Substance Abuse and will be advised where they may review the policy and statute.
Prior to testing, an applicant as defined in this policy shall be provided with a copy of the policy and statute.
B. SCOPE OF TESTING
Only individuals who are "applicants" as defined by this program and state law will be tested as "applicants". For the purpose of this program, an "applicant" will not be any person separated from employment by this employer while receiving a mandated benefit from or on account of this employer, including but not limited to Workers’ Compensa- tion, Unemployment Compensation and Family Medical Leave and for a period of 30 days beyond the termination of the benefit, nor will an "applicant" be any person separated from employment by this employer while receiving a non-mandated benefit from or on account of this employer for a period of 30 days beyond the separation.
1. Substances to be tested for
a. test procedure to be used and cut off limit for positive screening test.
MODEL SUBSTANCE ABUSE APPLICANT POLICY
PAGE 2
(1) Screening will be the Emit (Enzyme Multiplied Immunoassay Test) methodology
(2) Substances Screening
Concentration
Cut Off (In Urine)
Alcohol 0.02 G/100 ML
Amphetamine/Methamphetamine 1000 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 300 NG/ML
Cannabinoids 50 NG/ML
Cocaine and/or Metabolites 300 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates 2000 NG/ML
Phencyclidine 25 NG/ML
b. test procedure to be used and cut off limit for positive confirmation test.
(1) Confirmation test will be by GC/MS (Gas Chromotography/Mass Sectrometry) methodology
(2) Substances Confirmation
Concentration
Cut Off (In Urine)
6-acetyl morphine (only if morphine>2000) 10 NG/ML
Alcohol 0.02 G/100ML
Amphetamine/Methamphetamine 500 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 200 NG/ML
Cannabinoids 15 NG/ML
Cocaine and/or Metabolites 150 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates (Morphine, codeine) 2000 NG/ML Phencyclidine 25 NG/ML
MODEL SUBSTANCE ABUSE APPLICANT POLICY
PAGE 3
2. Testing of Applicants
Classifications or position titles to be tested:
[List classifications or positions to be tested (may be "All")]
Substance abuse tests will be administered only to those applicants who are in the above classification or position titles who (1) have been offered employment with the Company or who have been offered a position by the Company on a roster of
eligibility from which applicants shall be selected for employment.
C. ACTIONS TO BE TAKEN
Action to be taken for refusal to submit to a test: Applicant will not be hired
Action to be taken between a test and receipt of test results: Applicant will not be hired
Action to be taken based on a confirmed positive result from a test of an
applicant: Applicant will not be hired
D. TESTING PROCEDURES:
1. Identify sample collection facility or facilities
[List name and address of sample collection facility or facilities]
2. Method of sample collection
a. Procedure to segregate a portion of the sample at applicant’s
request:
At the request of the applicant, at the time the test sample is taken, a portion of the sample collected, sealed, and labeled according to State regulations and these procedures, will be segregated for that person’s own testing. This sample will be stored by the laboratory and chain of custody shall be maintained as provided in this policy. Within 5 days after notice of the test result is given to the applicant, the applicant shall notify the employer and the facility of the testing laboratory selected for that person’s own testing. The laboratory so selected must be licensed by the Maine Department of Human Services. The employer’s laboratory shall promptly send the segregated portion of the specimen to the
MODEL SUBSTANCE ABUSE APPLICANT POLICY
PAGE 4
selected laboratory, subject to the same chain of custody and security require- ments as observed for the employer’s specimen.
The applicant will be required to pay for the segregation of a second sample as well as the expense of said additional testing only if and when the applicant notifies the employer that the applicant actually wishes the test to be made and the applicant notifies the employer of the choice of laboratory to which the second sample is to be sent.
b. Procedure to collect:
The employer will not require an applicant to remove any clothing for the purpose of collecting a urine sample, except that the employer will require that an applicant leave any personal belongings other than clothing and any unnecessary coat, jacket or similar outer garments outside the collection area.
No applicant may be required to provide a urine sample while being observed, directly or indirectly, by another individual.
(If employer's policy calls for specimen assessment) Each urine specimen will be assessed by the person in charge of collection, in the presence of the applicant by measuring:
A. The temperature of the specimen within three (3) minutes of voiding - must be between 97-99 degrees F. (unless the applicant’s temperature is higher than 99 degrees or lower than 97 degrees F.)
B. The PH of the specimen - must be between 5-8.
and by evaluating the odor and color of the specimen for other signs of contamination.
If the specimen does not meet any of these assessment standards, the specimen
will be rejected and the applicant will be given an opportunity to provide a
second specimen. The applicant will remain under observation at the medical
facility and may be given liquids until the second specimen is provided. If the
second specimen fails to meet any assessment standard, the employer may deny
employment to the applicant and neither specimen will be tested for substances
of abuse.
MODEL SUBSTANCE ABUSE APPLICANT POLICY
PAGE 5
3. Storage of Sample
A. At collection point:
Samples will be collected in new, clean containers manufactured for the purpose of urine collection. Immediately after assessment, the container will be sealed with tamper-proof tape and labeled in the presence of the applicant. The seal will cover the cap and extend over the sides of the container. The label will contain the date and time of collection, and the identifying number of the applicant. All information on the label will be written clearly and with indelible ink. Samples will be transported or shipped promptly to the testing laboratory in a secure fashion, so as to prevent tampering. If shipment or transport is not feasible, the specimen shall be refrigerated within one hour, at less than 6 C for no more than three days, or frozen at -20 C or less, for no more than two weeks before shipment.
B. At laboratory:
All positive specimens will be retained by the laboratory in the original
containers in secure storage at freezing temperatures (-20 C or less) for
at least 6 months. Should legal challenge occur, the specimen will be
retained throughout the period of resolution of the challenge.
4. Chain of Custody
A. Labeling and Packaging:
Immediately upon collection of each sample, a chain of custody record
will be established for that sample, indicating the identity of each person
having control over the sample, and the times and dates of all transfers
or other actions pertaining to the sample.
B. Transport - Samples will be picked up from the facility within
24 hours of collecting the sample and will be transported in a secure
fashion, so as to avoid tampering.
Each person who takes custody of the sample in the course of transport
will record on the chain of custody log the date, time, transporter’s
name and employer’s name, origin and destination of the sample.
C. At Lab:
When a sample arrives at the lab, the person receiving the sample shall record the
MODEL SUBSTANCE ABUSE APPLICANT POLICY
PAGE 6
time of receipt and the location of each sample in the lab’s storage system. Any
technician or other person who removes the sample from storage or opens the sample
shall record the date, time, their name and purpose for removal or opening of the sample.
5. Identify testing laboratory:
NAME: [Name and address of testing laboratory or laboratories]
ADDRESS:
6. Procedure for notifying applicant of the result
The applicant will be notified by personal telephone call and confirmed by mail
unless the applicant otherwise instructs.
All laboratory reports, including the screening, confirmation and quality control data shall be reviewed by the [title of employer representative to receive report] as accurate. The report will identify the name of the laboratory, the drugs and metabolites tested for, whether the test results were negative or confirmed positive, and the cutoff levels for each substance. The report will include any available information concerning the margin of accuracy and precision of the test methods employed.
A. Unless agreed upon by the applicant, no report will show
the quantity of substance detected, but only the presence or absence
of that substance relative to the cutoff level.
B. No report will show that a substance was detected in a
screening test, unless the presence of the substance was confirmed
in the confirmatory test. Test results will be randomly delayed from
2 to 5 days so that the employer cannot gauge screening test
results from the time results are reported. In addition, all testing
will be billed to the employer at a single rate per sample tested
(which may be periodically adjusted by the laboratory).
C. No substance may be reported as present if the employer
did not request analysis for that substance.
D. Reports of samples segregated at the applicant’s request,
for testing by the applicant’s choice of laboratory, will be provided
to the applicant and to the employer.
Unless the applicant consents, all test results and any information
MODEL SUBSTANCE ABUSE APPLICANT POLICY
PAGE 7
acquired by the employer in the testing process is confidential and
may not be released to anyone except the applicant tested.
This requirement applies to the personnel of all laboratories involved
and to the employer. However, this does not prevent the disclosure
of results or information if:
1. Release of information is required or permitted by state
and federal law including release under 26 M.R.S.A.
Sec. 683 (8) (D), or
2. The use of this information is part of any grievance pro-
cedure, administrative hearing or civil action relating to
the imposition of the test or the use of test results.
The results of any test may not be required, requested or suggested
by the employer to be used in any criminal proceeding as provided
by 26 M.R.S.A. Sec. 685 (3) (B).
E. The laboratory shall retain records of confirmed positive
results in a numerical or quantitative form for at least two years.
7. Procedure for an applicant to appeal and contest the accuracy of a con-
firmed positive result.
If the applicant chose to segregate a portion of their sample and elects to submit that sample to a laboratory of their choice, the results of the second test will be controlling. To appeal the results of a confirmed positive result in lieu of testing the segregated sample, the applicant must fill out and sign the attached "Substance Abuse Test Appeal" form submitting information explaining or contesting the results, within five (5) working days after notice of a confirmed positive test result. The appeal process will be conducted without cost to the applicant. The applicant will then be scheduled to meet within 14 days with [list title(s) of person(s) who will review the appeal]. The applicant will explain the basis for the appeal and may be asked questions. After the meeting concludes, a written report of findings and conclusions will be prepared and a copy sent to the applicant.
MODEL SUBSTANCE ABUSE APPLICANT POLICY
(WITH MRO)
A. COVERED ESTABLISHMENT
Company name: [Provide name, address, etc. of employer]
Street Address:
Mailing Address:
Phone:
Contact regarding substance abuse testing policy:
[Name & Title of Contact]
[Phone Number of Contact]
Location(s) Covered: [List Location(s) Covered]
This policy complies with the Maine Substance Abuse Testing Law (26 MRSA Sec. 681-690) and the Maine Department of Labor Rules relating to Substance Abuse Testing (adopted October 27, 1989).
Applicants will be notified at the time of initial application that they may be tested for Substance Abuse and will be advised where they may review the policy and statute.
Prior to testing, an applicant as defined in this policy shall be provided with a copy of the policy and statute.
B. SCOPE OF TESTING
Only individuals who are "applicants" as defined by this program and state law will be tested as "applicants". For the purpose of this program, an "applicant" will not be
any person separated from employment by this employer while receiving a mandated
benefit from or on account of this employer, including but not limited to Workers’
Compensation, Unemployment Compensation and Family Medical Leave and for a
period of 30 days beyond the termination of the benefit, nor will an "applicant" be any
person separated from employment by this employer while receiving a non-mandated
benefit from or on account of this employer for a period of 30 days beyond the separa-
tion.
1. Substances to be tested for
a. test procedure to be used and cut off limit for positive screening test.
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 2
(1) Screening will be the Emit (Enzyme Multiplied Immunoassay Test) methodology
(2) Substances Screening
Concentration
Cut Off (In Urine)
Alcohol 0.02 G/100 ML
Amphetamine/Methamphetamine 1000 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 300 NG/ML
Cannabinoids 50 NG/ML
Cocaine and/or Metabolites 300 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates 2000 NG/ML
Phencyclidine 25 NG/ML
b. test procedure to be used and cut off limit for positive confirmation test.
(1) Confirmation test will be by GC/MS (Gas Chromotography/Mass Sectrometry) methodology
(2) Substances Confirmation
Concentration
Cut Off (In Urine)
6-acetyl morphine (only if morphine>2000) 10 NG/ML
Alcohol 0.02 G/100ML
Amphetamine/Methamphetamine 500 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 200 NG/ML
Cannabinoids 15 NG/ML
Cocaine and/or Metabolites 150 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates (Morphine,codeine) 2000 NG/ML Phencyclidine 25 NG/ML
2. Testing of Applicants
Classifications or position titles to be tested:
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 3
[List classifications or positions to be tested (may be "All")]
Substance abuse tests will be administered only to those applicants who are in the
above classification or position titles who (1) have been offered employment with
the Company or who have been offered a position by the Company on a roster of
eligibility from which applicants shall be selected for employment.
C. ACTIONS TO BE TAKEN
Action to be taken for refusal to submit to a test: Applicant will not be hired
Action to be taken between a test and receipt of test results: Applicant will not be hired
Action to be taken based on a confirmed positive result from a test of
an applicant: Applicant will not be hired
D. TESTING PROCEDURES:
1. Identify sample collection facility or facilities
[List name and address of sample collection facility or facilities]
2. Method of sample collection
a. Procedure to segregate a portion of the sample at applicant’s
request:
At the request of the applicant, at the time the test sample
is taken, a portion of the sample collected, sealed, and labeled
according to State regulations and these procedures, will be
segregated for that person’s own testing. This sample will
be stored by the laboratory and chain of custody shall be
maintained as provided in this policy. Within 5 days after
notice of the test result is given to the applicant, the appli-
cant shall notify the employer and the facility of the testing
laboratory selected for that person’s own testing. The labora-
tory so selected must be licensed by the Maine Department of
Human Services. The employer’s laboratory shall promptly
send the segregated portion of the specimen to the selected
laboratory, subject to the same chain of custody and security
requirements as observed for the employer’s specimen.
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 4
The applicant will be required to pay for the segregation of a
second sample as well as the expense of said additional testing
only if and when the applicant notifies the employer that the
applicant actually wishes the test to be made and the applicant
notifies the employer of the choice of laboratory to which the
second sample is to be sent.
b. Procedure to collect:
The employer will not require an applicant to remove any clothing
for the purpose of collecting a urine sample, except that the em-
ployer will require that an applicant leave any personal belongings other than clothing and any unnecessary coat, jacket or similar
outer garments outside the collection area.
No applicant may be required to provide a urine sample while being
observed, directly or indirectly, by another individual.
(If employer's policy calls for specimen assessment) Each urine specimen will be assessed by the person in charge of collection, in the presence of the applicant by measuring:
A. The temperature of the specimen within three (3) minutes of voiding - must
be between 97-99 degrees F. (unless the applicant’s temperature is higher
than 99 degrees or lower than 97 degrees F.)
B. The PH of the specimen - must be between 5-8.
and by evaluating the odor and color of the specimen for other signs of contami-
nation.
If the specimen does not meet any of these assessment standards, the specimen
will be rejected and the applicant will be given an opportunity to provide a
second specimen. The applicant will remain under observation at the medical
facility and may be given liquids until the second specimen is provided. If the
second specimen fails to meet any assessment standard, the employer may deny
employment to the applicant and neither specimen will be tested for substances
of abuse.
3. Storage of Sample
A. At collection point:
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 5
Samples will be collected in new, clean containers manufactured for the
purpose of urine collection. Immediately after assessment, the container
will be sealed with tamper-proof tape and labeled in the presence of the
applicant. The seal will cover the cap and extend over the sides of the
container. The label will contain the date and time of collection, and the
identifying number of the applicant. All information on the label will be written clearly and with indelible ink. Samples will be transported or shipped promptly to the testing laboratory in a secure fashion, so as to prevent tampering. If shipment or transport is not feasible, the specimens shall be refrigerated within
one hour, at less than 6 C for no more than three days, or frozen at -20 C or less, for no more than two weeks before shipment.
B. At laboratory:
All positive specimens will be retained by the laboratory in the original
containers in secure storage at freezing temperatures (-20 C or less) for
at least 6 months. Should legal challenge occur, the specimen will be
retained throughout the period of resolution of the challenge.
4. Chain of Custody
A. Labeling and Packaging:
Immediately upon collection of each sample, a chain of custody record
will be established for that sample, indicating the identity of each person
having control over the sample, and the times and dates of all transfers
or other actions pertaining to the sample.
B. Transport - Samples will be picked up from the facility within
24 hours of collecting the sample and will be transported in a secure
fashion, so as to avoid tampering.
Each person who takes custody of the sample in the course of transport
will record on the chain of custody log the date, time, transporter’s
name and employer’s name, origin and destination of the sample.
C. At Lab:
When a sample arrives at the lab, the person receiving the sample shall record the
time of receipt and the location of each sample in the lab’s storage system. Any
technician or other person who removes the sample from storage or opens the
sample shall record the date, time, their name and the purpose for removal or
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 6
opening of the sample.
5. Identify testing laboratory:
NAME: [Name and address of testing laboratory or laboratories]
ADDRESS:
6. Procedure for notifying applicant of the result
The applicant will be notified by personal telephone call and confirmed by mail
unless the applicant otherwise instructs.
All laboratory reports, including the screening, confirmation and quality
control data shall be reviewed by [the medical review officer] as accurate.
The report will identify the name of the laboratory, the drugs and metabolites
tested for, whether the test results were negative or confirmed positive, and the
cutoff levels for each substance. The report will include any available information
concerning the margin of accuracy and precision of the test methods employed.
.
A. Unless agreed upon by the applicant, no report shall show
the quantity of substance detected, but only the presence or absence
of that substance relative to the cutoff level.
B. No report will show that a substance was detected in a
screening test, unless the presence of the substance was confirmed
in the confirmatory test. Test results will be randomly delayed from
2 to 5 days so that the employer cannot gauge screening test
results from the time results are reported. In addition, all testing
will be billed to the employer at a single rate per sample tested
(which may be periodically adjusted by the laboratory).
C. No substance may be reported as present if the employer
did not request analysis for that substance.
D. Reports of samples segregated at the applicant’s request,
for testing by the applicant’s choice of laboratory, will be provided
to the applicant, the employer and the medical review officer.
Unless the applicant consents, all test results and any information
acquired by the employer and the medical review officer in the
testing process is confidential and may not be released to anyone
except the applicant tested. This requirement applies to the per-
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 7
sonnel of all laboratories involved, to the medical review officer
and to the employer. However, this does not prevent the
disclosure of results or information if:
1. Release of information is required or permitted by state
and federal law including release under 26 M.R.S.A.
Sec. 683 (8) (D), or
2. The use of this information is part of any grievance pro-
cedure, administrative hearing or civil action relating to
the imposition of the test or the use of test results.
The results of any test may not be required, requested or suggested
by the employer to be used in any criminal proceeding as provided
by 26 M.R.S.A. Sec. 685 (3) (B).
E. The laboratory shall retain records of confirmed positive
results in a numerical or quantitative form for at least two years.
F. All laboratory reports on substance abuse testing will be
submitted directly to the Employer’s Medical Review Officer
("MRO") and shall not be submitted to the employer. The
MRO for [Name of employer] will be [Name and address of
MRO]. The MRO will report to [Name of employer] all nega-
tive laboratory reports as negative. When the MRO receives
a confirmed positive laboratory report, the MRO will review
any available information submitted by the applicant to evaluate
whether there is a medical basis for an applicant’s drug usage
which could have led to a confirmed positive laboratory report.
The MRO shall contact the applicant and, upon the appli-
cant’s authorization, may contact the applicant’s physician to
obtain verified information upon the applicant’s legitimate drug
usage. If, in the opinion of the MRO, there is a legitimate
authorized medical explanation for a confirmed positive result
from the specimen obtained, the MRO will report a negative
test result to the employer.
The purpose of the MRO is to serve as a no-cost appeal of
the result and to provide further medical advice concern-
ing confirmed positive laboratory reports which may result
from legitimate and prescribed drug usage. The MRO
process has the additional benefit of protecting applicant con-
fidentiality in the case of confirmed positive laboratory results
MODEL SUBSTANCE ABUSE POLICY (APPLICANT WITH MRO)
PAGE 8
which, in the judgment of the MRO, are ultimately reported as
negative results to the employer.
7. Procedure for an applicant to appeal and contest the accuracy of a con-
firmed positive result.
If the applicant chose to segregate a portion of their sample and elects to
submit that sample to a laboratory of their choice, the results of the second
test will be controlling. The MRO process will serve as the appeal if the
applicant has not chosen to segregate their sample or chose not to pay
for testing of the segregated sample.
INSTRUCTIONS
These instructions are to assist you in submitting the paperwork for your Substance Abuse Testing Policy approval.
If you follow these instructions and the Model Policy, the review and approval of your policy will be expedited.
Please understand that an employee policy takes several hours to review. This program has become part of the Wage & Hour Division's responsibility without additional staff. Since we process these policies in the order they are received, it could be several months before your policy is reviewed. Thank you for your patience and understanding.
MODEL SUBSTANCE ABUSE POLICY
EMPLOYEE
A. COVERED ESTABLISHMENT
Company name: [Provide name, address, etc. of employer]
Street address:
Mailing address:
Phone:
Contact regarding substance abuse testing policy:
[Name, Location & Title of Contact]
[Phone Number of Contact]
Location(s) Covered: [List Location(s) Covered]
This policy complies with the Maine Substance Abuse Law (26 M.R.S.A. Sec. 681-690) and the Maine Department of Labor Rules Relating to Substance Abuse Testing (adopted October 27, 1989).
All employees will be provided a copy of the approved policy at least 30 days before any portion of the policy applicable to employees takes effect. All new employees will be given a copy of the approved policy prior to or upon beginning work.
B. SCOPE OF TESTING
An "employee" is defined in state law as "a person who is permitted, required or directed by any employer to engage in any employment for consideration of direct gain or profit". For the purpose of this program, a person separated from employment while receiving a mandated benefit, including but not limited to worker’s compensation, unemployment compensation and family medical leave, is an employee for the period the person receives the benefit and for a minimum of 30 days beyond the termination of the benefit. A person separated from employment while receiving a nonmandated benefit is an employee for a minimum of 30 days beyond the separation.
1. Substances to be Tested for:
a. test procedure to be used and cut off limit for positive screening test.
(1) Screening will be the Emit (Enzyme Multiplied Immunoassay Test) methodology
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 2
(2) Substances Screening
Concentration
Cut Off (In Urine)
Alcohol (in blood or urine) 0.02 G/100ML
Amphetamine/Methamphetamine 1000 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 300 NG/ML
Cannabinoids (in urine) 50 NG/ML
Cannabinoids (in blood) 10 NG/ML
Cocaine and/or Metabolites 300 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates 2000 NG/ML
Phencyclidine 25 NG/ML
b. test procedure to be used and cut off limit for positive confirmation test.
(1) Confirmation test will be by GC/MS (Gas Chromotography/Mass Sectrometry) methodology
(2) Substances Confirmation
Concentration
Cut Off (In Urine)
6-Acetyl Morphine (only if morphine>2000) 10 NG/ML
Alcohol (in blood or urine) 0.02 G/100ML
Amphetamine/Methamphetamine 500 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 200 NG/ML
Cannabinoids (in urine) 15 NG/ML
Cannabinoids (in blood) 10 NG/ML
Cocaine and/or Metabolites 150 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates (morphine, codeine) 2000 NG/ML
Phencyclidine 25 NG/ML
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 3
2. Probable Cause Testing
Classifications or position titles to be tested:
1. All (full-time, part-time and temporary employees in any classification) will be subject to the provisions of our substance abuse policy under probable cause testing (or may specify individual positions).
2. Probable cause means a reasonable ground for belief in the existence of facts that induce a person to believe an employee may be under the influence of a substance of abuse, provided that the existence of probable cause may not be based exclusively on any of the following:
A. Information received from an anonymous informant.
B. Any information tending to indicate that an employee may have
possessed or used a substance of abuse off duty, except when the
employee is observed possessing or ingesting any substance of
abuse either while on the premises or in the proximity of the em-
ployer premises during or immediately before the employee’s
working hours.
C. A single work-related accident.
3. Classification or position titles that may make a determination of probable cause:
Each (unit manager) is responsible for making a determination of probable cause. However, (other supervisory personnel, a licensed physician, nurse or the employer’s security personnel) can make the determination of probable cause to test an employee.
4. Method by which probable cause determination will be communicated to the employee:
Where the company has probable cause to believe that an employee is under the influence of drugs or alcohol, a review will be undertaken on an individual basis. The (unit manager) or other qualified staff must state in writing, the facts upon which this determination is based and provide a copy of the statement to the employee prior to testing.
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 4
Results of the test will be communicated to the employee in person by the
(unit manager or other staff personnel as appropriate) within three days of receiving the test results.
C. CONSEQUENCES OF TESTING
1. Action to be taken for refusal to submit to a test: An employee who refuses to submit to a drug screening probable cause test may be terminated.
2. Action to be taken while awaiting results of a test: During the period between testing and the receipt of the test results, the employee will be suspended with full pay and benefits (employee may be allowed to work while awaiting results or may have a change in assignment without a loss of pay or benefits).
3. Action to be taken based on confirmed positive result from test of an employee: Employee will be offered opportunity for up to six months of rehabilitation services.
4. Action to be taken upon refusal to use rehabilitation resources: Employee may be terminated.
5. Procedures for returning employee to the previously held job or position after rehabilitation: Upon successfully completed rehabilitation as determined by the provider after consulting with the Company, the employee is entitled to return to his/her previously held job with full pay and benefits unless conditions unrelated to the employee’s previous confired positive result make the employee’s return impossible. No reduction may be made in an employee’s previous benefits or rate of pay while waiting reassignment to work or while working in a position other than the previous job. The employee shall be reinstated to the previous position or another position with the equivalent rate of pay and benefits and with no loss of seniority within six months after returning to work in any capacity with the employer, unless the employee has received a subsequent confirmed positive test result within that time, or unless conditions unrelated to the employee’s previous confirmed positive test makes reinstatement or reassignment impossible.
6. Action to be taken based on a subsequent confirmed positive test: result: Employee may be terminated.
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 5
7. Action to be taken on employee’s voluntary admission: An employee who voluntarily admits a problem with substances of abuse may take advantage of the services offered through the Employee Assistance Program (see Rehabilitation Service). No adverse action will be taken against an employee simply because of such admission.
D. TESTING PROCEDURES
1. Identify sample collection facility or facilities
[List name and address of sample collection facility or facilities]
2. Method of sample collection
a. Procedure to segregate a portion of the sample at employee’s
request:
At the request of the employee, at the time the test sample is taken, a portion of
the sample collected, sealed, and labeled according to State regulations and these procedures, will be segregated for that person’s own testing. This sample will
be stored by the laboratory and chain of custody shall be maintained as provided in this policy. Within 5 days after notice of the test result is given to the employee, the employee shall notify the employer and the facility of the testing laboratory selected for that person’s own testing. The laboratory so selected must be licensed by the Maine Department of Human Services. The employer’s laboratory shall promptly send the segregated portion of the specimen to the selected laboratory, subject to the same chain of custody and security requirements as observed for the employer’s specimen. The employee will be required to pay for the segregation of a second sample as well as the expense of said additional testing only if and when the employee notifies the employer of the choice of laboratory to which the second sample is to be sent.
b. Employee’s election of a blood test:
For an alcohol or marijuana test, the employee may request that a blood sample be taken for testing. The employee must make this request at the time a test sample is taken. If the employee requests a blood test, no other sample from the employee will be tested for alcohol or marijuana. However, the employee may be required to provide a urine sample for testing of other drugs.
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 6
c. Procedure to collect urine:
The employer will not require an employee to remove any clothing for the purpose of collecting a urine sample, except that the employer will require that an employee leave any personal belongings other than clothing and any unnecessary coat, jacket or similar outer garments outside the collection area.
No employee may be required to provide a urine sample while being observed, directly or indirectly, by another individual.
(If the employer's policy calls for specimen assessment) Each urine specimen will be assessed by the person in charge of collection, in the presence of the employee by measuring:
A. The temperature of the specimen within three (3) minutes of voiding - must
be between 97-99 degrees F. (unless the employee’s temperature is higher
than 99 degrees or lower than 97 degrees F.)
B. The PH of the specimen - must be between 5-8.
and by evaluating the odor and color of the specimen for other signs of contami-
nation.
If the specimen does not meet any of these assessment standards, the specimen
will be rejected and the employee will be given an opportunity to provide a
second specimen. The employee will remain under observation at the medical
facility and may be given liquids until the second specimen is provided. If the
second specimen fails to meet any assessment standard, the employer may
consider this a refusal and neither specimen will be tested for substances
of abuse.
d. Procedure to collect blood:
Blood specimens (upon request by the employee for alcohol or marijuana) shall be
collected in new vacuum-activated blood collection tubes, with such preservatives
as may be specified by the testing laboratory, and shall be sealed with tamperproof seals, covering the cap and extending over the sides of the container. Blood
samples shall be taken by a licensed physician, registered physician’s assistant, registered nurse, or a person certified by the Department of Human Services to draw blood. Each specimen container shall be clearly and indelibly labeled with the date and time of collection and the name or other identifier associated with the
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 7
employee from whom the specimen was obtained. Sealing and labeling shall occur under the observation of the employee being tested.
3. Storage of Sample
A. At collection point:
Urine samples will be collected in new, clean containers manufactured for the
purpose of urine collection. Immediately after assessment, the container
will be sealed with tamper-proof tape and labeled in the presence of the applicant.
The seal will cover the cap and extend over the sides of the container. The label
will contain the date and time of collection, and the identifying number of
the applicant. All information on the label will be written clearly and with indelible ink. Samples will be transported or shipped promptly to the testing laboratory in a secure fashion, so as to prevent tampering. If shipment or transport is not feasible, the specimen will be refrigerated within one hour at less than 6 C for no more than three days, or frozen at -20 C or less, for no more than two weeks before shipment.
B. At laboratory:
All positive specimens will be retained by the laboratory in the original containers
in secure storage at freezing temperatures (-20 C or less) for at least 6 months.
Should legal challenge occur, the specimen will be retained throughout the period of resolution of the challenge.
4. Chain of Custody
A. Labeling and Packaging:
Immediately upon collection of each sample, a chain of custody record
established for that sample, indicating the identity of each person will be
having control over the sample, and the times and dates of all transfers or other
actions pertaining to the sample.
B. Transport:
Samples will be picked up from the facility within 24 hours of collecting the sample and will be transported in a secure fashion, so as to avoid tampering.
Each person who takes custody of the sample in the course of transport will
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 8
record on the chain of custody log the date, time, transporter’s name and employer’s name, origin and destination of the sample.
C. At Lab:
When a sample arrives at the lab, the person receiving the sample shall record the
time of receipt and the location of each sample in the lab’s storage system. Any
technician or other person who removes the sample from storage or opens the
sample shall record the date, time, their name and the purpose for removal or
opening of the sample.
5. Identify Testing Laboratory
NAME: [Name and address of testing laboratory or laboratories]
ADDRESS:
6. Procedure for Notifying Employee of the Result
The employee will be notified by personal telephone call and confirmed by mail
unless the employee otherwise instructs.
All laboratory reports, including the screening, confirmation and quality
control data shall be reviewed by [title of certifying officer to receive report] as accurate. The report will identify the name of the laboratory, the drugs and
metabolites tested for, whether the test results were negative or confirmed
positive, and the cutoff levels for each substance. The report will include
any available information concerning the margin of accuracy and precision
of the test methods employed.
A. Unless agreed upon by the employee, no report shall show
the quantity of substance detected, but only the presence or absence
of that substance relative to the cutoff level.
B. No report will show that a substance was detected in a
screening test, unless the presence of the substance was confirmed
in the confirmatory test. Test results will be randomly delayed from
2 to 5 days so that the employer cannot gauge screening test
results from the time results are reported. In addition, all testing
will be billed to the employer at a single rate per sample tested
(which may be periodically adjusted by the laboratory).
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 9
C. No substance may be reported as present if the employer
did not request analysis for that substance.
D. Reports of samples segregated at the employee’s request,
for testing by the employee’s choice of laboratory, will be provided
to the employee and the employer.
Unless the employee consents, all test results and any information
acquired by the employer in the testing process is confidential and may not be released to anyone except the employee tested. This requirement applies to the personnel of all laboratories involved and to the employer.
However, this does not prevent the disclosure of results or information if:
1. Release of information is required or permitted by state
and federal law including release under 26 M.R.S.A.
Sec. 683 (8) (D), or
2. The use of this information is part of any grievance pro-
cedure, administrative hearing or civil action relating to
the imposition of the test or the use of test results.
The results of any test may not be required, requested or suggested
by the employer to be used in any criminal proceeding as provided
by 26 M.R.S.A. Sec. 685 (3) (B).
E. The laboratory shall retain records of confirmed positive
results in a numerical or quantitative form for at least two years.
7. Procedure for an employee to appeal and contest the accuracy of a con-
firmed positive result.
If the employee chose to segregate a portion of their sample and elects to
submit that sample to a laboratory of their choice, the results of the second
test will be controlling.
To appeal the results of a confirmed positive result in lieu of testing the
segregated sample, the employee must fill out and sign the attached
"Substance Abuse Test Appeal" form submitting information explaining
or contesting the results, within five (5) working days after notice of a con-
firmed positive test result. The appeal process will be conducted without
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 10
cost to the employee. The employee will then be scheduled to meet within
14 days with [list title(s) of person(s) who will review the appeal]. The
employee will explain the basis for the appeal and may be asked questions.
After the meeting concludes, a written report of findings and conclusions
will be prepared and a copy sent to the employee.
E. DESCRIPTION OF REHABILITATION SERVICES
1. Description of employee assistance program (Required if over 20 full-time employees)
The Employee Assistance Program which has been certified under the State’s Department of Human Services "Regulations for Employee Assistance Programs for Employers Operating in the State of Maine" provides a range of services to employees for substance abuse. A copy of the DHS approval, description of our program and explanation of how to obtain services is attached. (Be sure to attach this information).
2. Description of other rehabilitation services.
(If there are other rehabilitation services available, a description on how to obtain the services should be provided here. If there are none, it should be noted).
3. Procedure to obtain services.
For an employee to take advantage of the employee assistance program, an employee may directly call the employee assistant program or may ask for a referral through the Company. The telephone number for the EAP program is (provide telephone number).
4. Description of method of payment for rehabilitation services.
(If company has over 20 full-time employees): If an employee elects to use the services provided under the Company's Employee Assistance Program, the cost will be covered by the Company. If any employee elects to use another rehabilitation program, some of those costs may be covered by the employee's health insurance. To the extent that costs may not be covered by health insurance, the additional costs are divided equally between the Company and the employee. If the employee has difficulty paying his or her share of these expenses, the
MODEL SUBSTANCE ABUSE EMPLOYEE POLICY
PAGE 11
employee should consult with the Company to arrange for a loan or advance against future earnings through a payroll deduction plan.
(If 20 or fewer full-time employees): Except to the extent that costs are covered by a health insurance plan, the employee shall be responsible for the payment of any public or private rehabilitation program.
5. Testing upon return to work after completion of rehabilitation.
The employee may be required to submit to one subsequent substance abuse test anytime between 90 days and one year after the date of the employee's prior test.
MODEL SUBSTANCE ABUSE POLICY
APPLICANT (POINT OF COLLECTION)
A. COVERED ESTABLISHMENT
Company name: [Provide name, address, phone number of employer]
Street address:
Mailing address:
Phone:
Contact regarding substance abuse testing policy:
[Name & Title of Contact]
[Phone Number of Contact]
Location(s) Covered: [List Location(s) Covered]
Applicants will be notified at the time of initial application that they may be tested for Substance Abuse and will be advised where they may review the policy and statute.
Prior to testing, an applicant as defined in this policy shall be provided with a copy of the policy and statute.
B. SCOPE OF TESTING
Only individuals who are applicants as defined by this program and state law will be tested as applicants. For the purpose of this program, an applicant is a person who has been offered work or placed on a roster of eligibility. A person separated from employment by this employer while receiving a mandated benefit from or on account of this employer, including but not limited to Workers’ Compensation, Unemployment Compensation or Family Medical Leave and for a period of 30 days beyond the termination of the benefit is not an applicant. Any person separated from employment by this employer while receiving a non-mandated benefit from or on account of this employer for a period of 30 days beyond the separation is not an applicant.
1. Substances to be tested for
a. test procedure to be used and cut off limit for positive screening test.
(1) Screening will be the Emit (Enzyme Multiplied Immunoassay Test) methodology
PAGE 2
(2) Substances Screening
Concentration
Cut Off (In Urine)
Alcohol 0.02 G/100 ML
Amphetamine/Methamphetamine 1000 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 300 NG/ML
Cannabinoids 50 NG/ML
Cocaine and/or Metabolites 300 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates 2000 NG/ML
Phencyclidine 25 NG/ML
b. test procedure to be used and cut off limit for positive confirmation test.
(1) Confirmation test will be by GC/MS (Gas Chromotography/Mass Sectrometry) methodology
(2) Substances Confirmation
Concentration
Cut Off (In Urine)
6-acetyl morphine (only if morphine>2000) 10 NG/ML
Alcohol 0.02 G/100ML
Amphetamine/Methamphetamine 500 NG/ML
Barbiturates 300 NG/ML
Benzodiazepines 200 NG/ML
Cannabinoids 15 NG/ML
Cocaine and/or Metabolites 150 NG/ML
Methadone 300 NG/ML
Methaqualone 300 NG/ML
Opiates (Morphine, codeine) 2000 NG/ML Phencyclidine 25 NG/ML
2. Testing of Applicants
Classifications or position titles to be tested:
[List classifications or positions to be tested (may be "All")]
PAGE 3
Substance abuse tests will be administered only to those applicants who are in the described classification or position titles who (1) have been offered employment with the Company or who have been offered a position by the Company on a roster of eligibility from which applicants shall be selected for employment.
3. Point of Collection Testing
The POCT is an initial screen test performed at the point of collection (POC)/collection site through the use of a non-instrumented POC testing device approved by the Federal Food and Drug Administration. This type of testing will be used for applicants only. The POCT procedures outlined in this policy do not replace or supersede any other drug testing policies or requirements.
Point of Collection Testing is a process that has been put into place in order to complement the existing drug testing procedures. Point of Collection Testing is a screening conducted at the point of collection site rather than a laboratory in order to determine the presence of illicit substances (see list of substances to be tested).
C. ACTIONS TO BE TAKEN
Action to be taken for refusal to submit to a test: Applicant will not be hired
Action to be taken between a test and receipt of test results: Applicant will not be hired
Action to be taken based on a confirmed positive result from a test of an
applicant: Applicant will not be hired
D. TESTING PROCEDURES:
1. Identify sample collection facility or facilities
[List name and address of sample collection facility or facilities]
Maintaining Confidentiality:
In order to ensure confidentiality of applicants during the POCT process, POCT will take place offsite at the POC/collection site with individuals who are trained in the POCT process, following approved Chain of Custody procedures. Staff who will
perform POCT will be instructed in the proper manner of collecting samples, reading results and maintaining a proper chain of custody. At a minimum, the training will consist of the following:
PAGE 4
applied to the sample and the donor has completed the donor information and donor affidavit on the chain of custody form;
Any sample that results in a negative test will be destroyed. Any sample that results in a positive result will be sent to the approved laboratory following approved Chain of Custody procedures for confirmation testing as described in Section 4 of the Policy.
2. Method of sample collection
a. Procedure to segregate a portion of the sample at applicant’s request:
At the request of the applicant, at the time the test sample is taken, a portion of the sample collected, sealed, and labeled according to State regulations and these procedures, will be segregated for that person’s own testing. This sample will be stored by the laboratory and chain of custody shall be maintained as provided in this policy. Within 5 days after notice of the test result is given to the applicant, the applicant shall notify the employer and the facility of the testing laboratory selected for that person’s own testing. The laboratory so selected must be licensed by the Maine Department of Human Services. The employer’s laboratory shall promptly send the segregated portion of the specimen to the selected laboratory, subject to the same chain of custody and security require-ments as observed for the employer’s specimen.The applicant will be required to pay for the segregation of a second sample as well as the expense of said additional testing only if and when the applicant notifies the employer that the applicant actually wishes the test to be made and the applicant notifies the employer of the choice of laboratory to which the second sample is to be sent.
b. Procedure to collect:
The employer will not require an applicant to remove any clothing for the purpose
PAGE 5
of collecting a urine sample, except that the employer will require that an applicant leave any personal belongings other than clothing and any unnecessary coat, jacket or similar outer garments outside the collection area.
No applicant may be required to provide a urine sample while being observed, directly or indirectly, by another individual. The collector will follow appropriate collection procedures regarding security of the facility; check for picture ID, etc.
The collector begins the chain of custody process by completing the on-site chain of custody form and providing the appropriate information: Company, MRO (if MRO is used), Donor, Reason for test and Collection Site. The collector opens the collection kit and removes bottles and collection cup in the presence of the donor. The donor goes into the collection stall and provides a specimen into collection cup.
(If employer's policy calls for specimen assessment) Each urine specimen will be assessed by the person in charge of collection, in the presence of the applicant by measuring:
A. The temperature of the specimen within three (3) minutes of voiding - must be between 97-99 degrees F. (unless the applicant’s temperature is higher than 99 degrees or lower than 97 degrees F.)
B. The PH of the specimen - must be between 5-8.
and by evaluating the odor and color of the specimen for other signs of contamination.
If the specimen does not meet any of these assessment standards, the specimen
will be rejected and the applicant will be given an opportunity to provide a
second specimen. The applicant will remain under observation at the medical
facility and may be given liquids until the second specimen is provided. If the
second specimen fails to meet any assessment standard, the employer may deny
employment to the applicant and neither specimen will be tested for substances
of abuse.
In the presence of the donor, the collector shall pour off at least 30 ml in Bottle A for use as a confirmation test (if it becomes necessary). If applicant requests a segregated sample as described in policy, the collector shall pour off another 30 ml into Bottle B. The collector shall place the bottle seals over the bottles and
have donor initial the seals. Chain of Custody procedure continues and the collector and donor must sign.
PAGE 6
The collector performs the following steps in testing the remainder of the specimen:
If additional testing is needed, Bottle A and the chain of custody form are sealed in the tamper proof bag and shipped promptly to the laboratory of GC/MS confirmation for the drug(s) indicated. If shipment or transport is not feasible, the specimen will be refrigerated within one hour at less than 6 C for no more than three days, or frozen at -20 C or less, for no more than two weeks before shipment.
IF ADDITIONAL TESTING IS NEEDED,THE FOLLOWING PROCEDURES SHALL BE FOLLOWED:
3. Storage of Sample
B. At laboratory:
All positive specimens will be retained by the laboratory in the original
containers in secure storage at freezing temperatures (-20 C or less) for
at least 6 months. Should legal challenge occur, the specimen will be
retained throughout the period of resolution of the challenge.
4. Chain of Custody
A. Labeling and Packaging:
Immediately upon collection of each sample, a chain of custody record for that
sample, indicating the identity of each person having control over the sample,
and the times and dates of all transfers or other actions pertaining to the sample.
B. Transport:
Samples will be picked up from the facility within 24 hours of collecting
the sample and will be transported in a secure fashion, so as to avoid tampering.
PAGE 7
Each person who takes custody of the sample in the course of transport will
record on the chain of custody log the date, time, transporter’s name and
employer’s name, origin and destination of the sample.
C. At Lab:
When a sample arrives at the lab, the person receiving the sample shall record the
time of receipt and the location of each sample in the lab’s storage system. Any
technician or other person who removes the sample from storage or opens the sample shall record the date, time, their name and purpose for removal or opening of the sample.
5. Identify testing laboratory:
NAME: [Insert Name and address of testing laboratory or laboratories]
ADDRESS:
6. Procedure for notifying applicant of the result
The applicant will be notified by personal telephone call and confirmed by mail
unless the applicant otherwise instructs.
All laboratory reports, including the screening, confirmation and quality control data shall be reviewed by the [title of employer representative to receive report] as accurate. The report will identify the name of the laboratory, the drugs and metabolites tested for, whether the test results were negative or confirmed positive, and the cutoff levels for each substance. The report will include any available information concerning the margin of accuracy and precision of the test methods employed.
A. Unless agreed upon by the applicant, no report will show
the quantity of substance detected, but only the presence or absence
of that substance relative to the cutoff level.
B. No report will show that a substance was detected in a
screening test, unless the presence of the substance was confirmed
in the confirmatory test. Test results will be randomly delayed from
2 to 5 days so that the employer cannot gauge screening test results from the time results are reported. In addition, all testing will be billed to the employer at a single rate per sample tested(which may be periodically adjusted by the laboratory).
C. No substance may be reported as present if the employer
did not request analysis for that substance.
PAGE 8
D. Reports of samples segregated at the applicant’s request,
for testing by the applicant’s choice of laboratory, will be provided
to the applicant and to the employer.
Unless the applicant consents, all test results and any information
acquired by the employer in the testing process is confidential and
may not be released to anyone except the applicant tested.
This requirement applies to the personnel of all laboratories involved
and to the employer. However, this does not prevent the disclosure
of results or information if:
1. Release of information is required or permitted by state
and federal law including release under 26 M.R.S.A.
Sec. 683 (8) (D), or
2. The use of this information is part of any grievance pro-
cedure, administrative hearing or civil action relating to
the imposition of the test or the use of test results.
The results of any test may not be required, requested or suggested
by the employer to be used in any criminal proceeding as provided
by 26 M.R.S.A. Sec. 685 (3) (B).
E. The laboratory shall retain records of confirmed positive results in a numerical or quantitative form for at least two years.
7. Procedure for an applicant to appeal and contest the accuracy of a confirmed positive result.
If the applicant chose to segregate a portion of their sample and elects to submit that sample to a laboratory of their choice, the results of the second test will be controlling. To appeal the results of a confirmed positive result in lieu of testing the segregated sample, the applicant must fill out and sign the attached "Substance Abuse Test Appeal" form submitting information explaining or contesting the results, within five (5) working days after notice of a confirmed positive test result. The appeal process will be conducted without cost to the applicant. The applicant will then be scheduled to meet within 14 days with [list title(s) of person(s) who will review the appeal]. The applicant will explain the basis for the appeal and may be asked questions. After the meeting concludes, a written report of findings and conclusions will be prepared and a copy sent to the applicant.