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Reasonable Cause Draft 1

The document outlines the procedure for determining reasonable cause for drug or alcohol testing in the workplace. It defines reasonable cause, lists observable indicators for impairment, and provides a step-by-step process for supervisors to follow if they suspect an employee is impaired. The document includes sections for recording individual information, observed behaviors, and supervisor summaries.

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xoxim64054
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20 views3 pages

Reasonable Cause Draft 1

The document outlines the procedure for determining reasonable cause for drug or alcohol testing in the workplace. It defines reasonable cause, lists observable indicators for impairment, and provides a step-by-step process for supervisors to follow if they suspect an employee is impaired. The document includes sections for recording individual information, observed behaviors, and supervisor summaries.

Uploaded by

xoxim64054
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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** Strictly Confidential**

Determining Reasonable Cause

Reasonable cause is defined as a legitimate, non-discriminatory belief, formed on the


basis of clear, observable, and articulable facts, that an employee is under the influence
of or impaired by alcohol or drugs while on duty or in the workplace.

Reasonable cause testing may be required where: (1) the employee admits impairment
at work and/or (2) there are reasonable grounds based on observable indicators (below).

1. Notify the employee and immediately remove them from duty.

2. Call ########## to book testing.

3. Arrange transportation for employee to and from the collection facility.

Individual Information

Name and Perm #:

Time of Incident:

Location:

Supervisor Name:

Department:

STEP 1: Behaviours Observed


Please circle all that apply below

Breath (smell of Alcohol or Marijuana)


None Faint Moderate Strong

Speech
Normal Whispering Slow Slurred Confused Rapid Loud Cursing

Eyes (if wearing glasses ask for them to be removed)


Normal Watery Droopy Dilated pupils Constricted Bloodshot
(big) pupil (small)

Walking
Normal Unsteady Stumbling Swaying Falling
** Strictly Confidential**

Attitude/ Mood
Normal Talkative Carefree Excited Giddy Nervous Combative Angry Drowsy Crying

Actions
Normal Laughin Burping Hiccuppin Fightin Vomitin Hyper Avoiding Shakin Runny
g g g g communicati g nose
on hands
or body

Other notable actions, statements or behaviors:

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____________________

STEP 2: Supervisor Summary of Events

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
____________________________

STEP 3: Admission of to use of Alcohol or Drugs? YES / NO

If yes fill out below:

When?

What substance?

How much?

Taken where?

STEP 4: TEST & FOLLOW UP (circle below)

Testing required? Yes / No

Employee agreed to test / Employee refused to test


** Strictly Confidential**
Supervisor Signature

Date

** line about who to send to etc***

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