Confirm that an employee received and understands your drug and alcohol policy.
A written policy sets clear expectations, especially in safety-sensitive roles such as driving, machinery or care work. The acknowledgment confirms the employee received it.
Testing, marijuana laws, privacy and disability protections vary widely by state and may be governed by federal rules for some roles. Do not use a testing policy without legal advice.
11 items. Fill it in on screen or print a copy.
A construction company updates its policy for crane operators and drivers, which are safety-sensitive roles. After attorney review, each affected employee signs the new acknowledgment at a toolbox talk, and signed forms are kept confidentially by HR.
DOT rules require CDL drivers to receive the policy and sign for it, and they bar alcohol use within four hours before safety-sensitive work. For non-DOT employees, state laws on testing vary, so the acknowledgment proves the employee knew the rules that applied.
| Employee and role | Curtis, CDL truck driver |
|---|---|
| Policy and version | Drug and Alcohol Policy, v3, Oct 2026 |
| Prohibited conduct | Use or impairment on duty; no alcohol 4 hours before duty |
| Testing | DOT pre-employment, random, post-accident, reasonable suspicion |
| Assistance | EAP phone number on page 2 |
| Consequences | Removed from safety-sensitive duty; SAP referral |
| Signed | Nov 3 at toolbox talk; copy to HR file |
Blue Ridge Paving in Roanoke uses this DOT version for Curtis because he drives with a CDL. Office staff sign a separate non-DOT version, since the testing and referral rules differ.
It depends on state law and the role. Get legal advice.
Rules vary by state.
HR, kept confidentially.
Usually yes, with extra rules for safety-sensitive roles.
Yes, for CDL drivers covered by 49 CFR Part 382. Employers must give each driver educational materials on the policy and get a signed statement that the driver received them. The signed receipt goes in the driver’s file.
OSHA has warned that blanket post-injury testing can discourage injury reporting and may be retaliation under its recordkeeping rule. Testing is usually fine when drug use could have contributed, or when another law such as DOT rules requires it. Check state law as well.
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Employees can fill in and sign forms like this in the EZTime app, and the signed copy lands in their digital employee file. Try it for 14 days, no credit card.