Certification Drug Free Workplace Form – Fill Out and Use This PDF

Certification for

a Drug-Free Workplace

U.S. Department of Housing and Urban Development

I certify that the above named Applicant will or will continue to provide a drug-free workplace by:

a. Publishing a statement notifying employees that the un- lawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the Applicant's work- place and specifying the actions that will be taken against employees for violation of such prohibition.

b.Establishing an on-going drug-free awareness program to inform employees ---

(1)The dangers of drug abuse in the workplace;

(2)The Applicant's policy of maintaining a drug-free

workplace;

(3)Any available drug counseling, rehabilitation, and employee assistance programs; and

(4)The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace.

c. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph a.;

d.Notifying the employee in the statement required by para- graph a. that, as a condition of employment under the grant, the employee will ---

(1)Abide by the terms of the statement; and

(2)Notify the employer in writing of his or her convic- tion for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;

e. Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph d.(2) from an em- ployee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, includ- ing position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federalagency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant;

f.Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph d.(2), with respect to any employee who is so convicted ---

(1)Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

(2)Requiring such employee to participate satisfacto- rily in a drug abuse assistance or rehabilitation program ap- proved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

g.Making a good faith effort to continue to maintain a drug- free workplace through implementation of paragraphs a. thru f.

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if there are workplaces on file that are not identified on the attached sheets.