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78 <br />I have received a copy of Little Canada's Alcohol and Drug Use and Testing Policy for Safety-Sensitive <br />Drivers and have been provided information on the following: <br /> <br />1. The person designated by the employer to answer questions about these materials; <br /> <br />2. Who is subject to alcohol misuse and controlled substance requirements; <br /> <br />3. Explanation of a safety-sensitive function; <br /> <br />4. What driver conduct is prohibited; <br /> <br />5. Circumstances for drug and/or alcohol testing; <br /> <br />6. Procedures used to test for the presence of drugs and/or alcohol; <br /> <br />7. The requirement that employees submit to controlled substance and alcohol testing; <br /> <br />8. An explanation of what constitutes a refusal to submit to testing; <br /> <br />9. The consequences for drivers violating the prohibitions of this rule, including the <br />immediate removal of the driver from safety-sensitive functions; <br /> <br />10. The consequences for drivers found to have an alcohol concentration level of 0.02 or <br />greater, but less than 0.04; and <br /> <br />11. Information concerning the effects of alcohol and controlled substance use on an <br />individual's health, work, and personal life. Signs and symptoms of an alcohol or <br />controlled substances problem and available methods of intervening when an alcohol or <br />a controlled substances problem is suspected, including confrontation, referral to an <br />employee assistance program and/or referral to management. <br /> <br /> <br />Signature: _______________________________ Date: _____________ <br /> <br />Please print name: ___________________________________ <br /> <br />