Drug and Alcohol Testing Program
TITLE OF FORM: REASONABLE CAUSE DOCUMENTATION
This form must be used to document the reasons the district may have to suspect that a driver is either using controlled substances or misusing alcohol.
TWO School District personnel/supervisors must fill out this form and agree on the observed symptoms.
Usually this is the Supervisor of the driver and a district administration official.
1. Be sure to fill in the information requested. You must be specific as to time, location and date. Be sure to document only symptoms or signs that you personally observe. Do not indicate symptoms or signs that others have told you they have observed.
2. Both District officials must sign the form.
3. You will then have to call the employee to come in for a meeting and present the driver with the information. If, after you have met with the driver and determine there is a need for testing, you must request that he submit to the appropriate testing. Use the Drug/Alcohol Test Referral Form, check the Reasonable Suspicion box, and the tests you are requesting (either drug, alcohol or both). If the driver refuses to be tested then you will document the refusal using the Random Absentee Report form. This refusal is treated just like a positive drug and/or alcohol test. See the procedures for a positive test in this manual.
4. You must escort the driver to the collection facility. Be sure to take a collection kit, Custody and Control Form, label and the referral form.
5. If the Breathalyzer test is positive you must drive the employee home or make arrangements for his/her transportation to his/her home. You must not allow the driver to operate any private vehicle or any district vehicle. Once you have deposited the driver at home then the district responsibility for the driver and his actions has ended. (See the procedures for dealing with a positive alcohol result in this manual)
6. Whether the test is positive for Alcohol or Drugs, you must remove the driver from duty in a safety sensitive function and initiate appropriate district disciplinary procedures. See the procedures for positive drug/alcohol test results in this manual.
IMPORTANT: You may terminate the employee only if your school district's policy clearly states that employment termination is the penalty for a positive drug or alcohol test under the DOT Regulations. (i.e. a "zero tolerance" policy)
REMEMBER: DOCUMENT, DOCUMENT, DOCUMENT, DOCUMENT.
If you have any questions, please call Linda Ploof at Preferred Alliance (877) 272-5227. Direct Line: 209-858-3239 or e-mail at .
Keep a copy of this form in the employee's DOT file. These files should be kept in a secured file separate from personnel files.
REASONABLE CAUSE DOCUMENTATION
Driver Name ______
Date of Observation ______
month, day, year
Time of Observation From ______am / pm To:______am / pm
Location: ______
Observed Behavior (circle all that apply)
SPEECHBALANCEWALKING
thickincoherentunsteadystumbling
rapidexcessively talkativeswayingstaggering
slurredfallinggrasping for support
EMOTIONAL INDICATORSPHYSICAL INDICATORS
depressionwithdrawalpupils dilatedneglect of personal hygiene
anxietymoodinesscold sweatschronic redness of eyes
alienationirritabilityrapid breathingnoticeable weight loss
loss of appetiteodor of marijuanatremors
Other abnormal behavior observed______
______
______
To the best of my knowledge and belief, this report represents the appearance, behavior and/or conduct of the above-named driver, observed by me and upon which I base my decision to require said driver to submit to reasonable cause drug testing.
School District ______
Above behavior witnessed by:
______
Signature of District OfficialSignature of Driver Supervisor
______
DateDate