403 - Employees' Health and Well-Being

403 - Employees' Health and Well-Being dawn.gibson.cm… Wed, 02/10/2021 - 14:21

403.01 - Employee Physical Examinations

403.01 - Employee Physical Examinations

The Independence Community School District believes good health is important to job performance. School bus drivers will present evidence of good health upon initial hire and every other year in the form of a physical examination report, unless otherwise required by law or medical opinion.

The cost of the initial examination will be paid by the school district. The form indicating the employee is able to perform the duties, with or without reasonable accommodation, for which the employee was hired, must be returned prior to the performance of duties. The cost of bus driver renewal physicals will be paid by the school district. The school district may provide the standard examination form to be completed by the personal physician of the employee or a certified medical examiner for bus drivers. 

Employees of the Preschool Program at the Early Childhood Center will present evidence of good health with tuberculosis (TB) screening upon initial hire and every other year in the form of a physical examination report, unless otherwise required by law or medical opinion.  The school district may provide the standard examination form to be completed by the personal physician of the employee or a certified medical examiner.  The Board will pay to the employee the cost of such examination upon presentation to the Board by the employee the paid receipt of the examining physician. 

Employees whose physical or mental health, in the judgment of the administration, may be in doubt will submit to additional examinations to the extent job-related and consistent with business necessity, when requested to do so, at the expense of the school district.

The district will comply with occupational safety and health requirements as applicable to its employees in accordance with law.

 

 

Legal Reference:         29 C.F.R. § 1910.1030.

                                  49 C.F.R. §§ 391.41 – 391.49.

          Iowa Code §§ 20; 279.8; 321.376.

        281 I.A.C. 43.15; 43.17.

 

Cross Reference:       403          Employees' Health and Well-Being

 

 

Approved 08/15/2016                           Reviewed 05/20/2019                           Revised 05/20/2019

                                                                             05/16/2022                                         05/16/2022

 

dawn.gibson.cm… Mon, 02/15/2021 - 10:18

403.02 - Employee Injury on the Job

403.02 - Employee Injury on the Job

 

When an employee becomes seriously injured on the job, the principal, direct supervisor or superintendent needs to be notified immediately.  Injuries thought to be emergent should be taken to the nearest emergency medical treatment center for medical management.  The employee’s supervisor will attempt to notify a member of the family, or an individual of close relationship, as soon as the employee’s supervisor becomes aware of the injury.

It will be the responsibility of the supervisor or principal of the injured employee to inform the superintendent within twenty-four hours of the occurrence.  It will be the responsibility of the employee's immediate supervisor to file an accident report within twenty-four hours after the employee reported the injury and provide a copy to the administration office.

If continuous medical follow up is needed, this follow up will be performed by a workman compensation medical provider as designated by the district.

It will be the responsibility of the employee to file claims, such as workers' compensation, through the board secretary.

 

 

Legal Reference:          Iowa Code §§ 85; 279.40; 613.17 (2003).

                                    1972 Op. Att'y Gen. 177.

 

Cross Reference:          403      Employees' Health and Well-Being

                                    409.2   Licensed Employee Personal Illness Leave

                                    414.2   Classified Employee Personal Illness Leave

                                    804.3   First Aid

 

 

Approved 11/1/2004                             Reviewed 10/15/2007                           Revised 12/19/2016

                                                                             11/21/2011                                       05/16/2022

                                                                             05/16/2022

 

 

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:03

403.03 - Communicable Diseases - Employees

403.03 - Communicable Diseases - Employees

Employees with a communicable disease will be allowed to perform their customary employment duties provided they are able to perform the essential functions of their position and their presence does not create a substantial risk of illness or transmission to students or other employees.  The term "communicable disease" shall mean an infectious or contagious disease spread from person to person, or animal to person, or as defined by law.

Prevention and control of communicable diseases will be included in the school district's bloodborne pathogens exposure control plan.  The procedures will include scope and application, definitions, exposure control, methods of compliance, universal precautions, vaccination, post-exposure evaluation, follow-up, communication of hazards to employees and record keeping.  This plan will be reviewed annually by the superintendent and school nurse.

The health risk to immunodepressed employees will be determined by their personal physician.  The health risk to others in the school district environment from the presence of an employee with a communicable disease will be determined on a case-by-case basis by the employee's personal physician, a physician chosen by the school district or public health officials.

An employee who is at work and who has a communicable disease which creates a substantial risk of harm to a student, coworkers, or others at the workplace will report the condition to the Superintendent any time the employee is aware that the disease actively creates such risk.

Health data of an employee is confidential and it will not be disclosed to third parties.  Employee medical records will be kept in a file separate from their personal file.

It will be the responsibility of the superintendent, in conjunction with the school nurse, to develop administrative regulations stating the procedures for dealing with employees with a communicable disease.

 

 

Legal Reference:          29 U.S.C. §§ 794, 1910.

                                    42 U.S.C. §§ 12101 et seq.

                                    45 C.F.R. Pt. 84.3.

                                    Iowa Code chs. 139(a); 141(a).

                                    641 I.A.C. 1, .2, .7.

 

Cross Reference:          401.6   Employee Records

                                    403.1   Employee Physical Examinations

                                    507.3   Communicable Diseases - Students

 

Approved 11/1/2004                             Reviewed 11/21/2011                           Revised 11/19/2007

                                                                             05/16/2022                                         12/19/2016

                                                                                                                                       05/16/2022

dawn.gibson.cm… Mon, 02/15/2021 - 11:04

403.3E1 - Hepatitis B Vaccine Information and Record

403.3E1 - Hepatitis B Vaccine Information and Record

The Disease

Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV) which causes death in 1-2% of those infected.  Most people with HBV recover completely, but approximately 5-10% become chronic carriers of the virus.  Most of these people have no symptoms, but can continue to transmit the disease to others.  Some may develop chronic active hepatitis and cirrhosis.  HBV may be a causative factor in the development of liver cancer.  Immunization against HBV can prevent acute hepatitis and its complications.

The Vaccine

The HBV vaccine is produced from yeast cells.  It has been extensively tested for safety and effectiveness in large scale clinical trials.

Approximately 90 percent of healthy people who receive two doses of the vaccine and a third dose as a booster achieve high levels of surface antibody (anti-HBs) and protection against the virus.  The HBV vaccine is recommended for workers with potential for contact with blood or body fluids.  Full immunization requires three doses of the vaccine over a six-month period, although some persons may not develop immunity even after three doses.

There is no evidence that the vaccine has ever caused Hepatitis B.  However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical hepatitis in spite of immunization.

Dosage and Administration

The vaccine is given in three intramuscular doses in the deltoid muscle.  Two initial doses are given one month apart and the third dose is given six months after the first.

Possible Vaccine Side Effects

The incidence of side effects is very low.  No serious side effects have been reported with the vaccine.  Ten to 20 percent of persons experience tenderness and redness at the site of injection and low grade fever.  Rash, nausea, joint pain, and mild fatigue have also been reported.  The possibility exists that other side effects may be identified with more extensive use.

 

CONSENT OF HEPATITIS B VACCINATION

I have knowledge of Hepatitis B and the Hepatitis B vaccination.  I have had an opportunity to ask questions of a qualified nurse or physician and understand the benefits and risks of Hepatitis B vaccination.  I understand that I must have three doses of the vaccine to obtain immunity.  However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience side effects from the vaccine.  I give my consent to be vaccinated for Hepatitis B.

 

_____________________________________________________________     _______________________________________
Signature of Employee (consent for Hepatitis B vaccination)                                             Date

 

_____________________________________________________________     _______________________________________
Signature of Witness                                                                                                                            Date

 

 

REFUSAL OF HEPATITIS B VACCINATION

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus infection.  I have been given the opportunity to be vaccinated with Hepatitis B vaccine at no charge to myself.  However, I decline the Hepatitis B vaccination at this time.  I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.  If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

 

_____________________________________________________________     _______________________________________
Signature of Employee (refusal for Hepatitis B vaccination)                                               Date

 

_____________________________________________________________     _______________________________________
Signature of Witness                                                                                                                            Date

 

I refuse because I believe I have (check one)

                       started the series                                             completed the series

            _____ other, please describe:  _____________________________________________________

 

 

RELEASE FOR HEPATITIS B MEDICAL INFORMATION

 

I hereby authorize _____________________________________________________________________
                                         (name and address of individual or organization holding Hepatitis B records)

to release to the Independence Community School District my Hepatitis B vaccination records for required

employee records. 

I hereby authorize release of my Hepatitis B status to a health care provider in the event of an exposure incident.

 

_____________________________________________________________     _______________________________________
Signature of Employee                                                                                                                      Date

 

_____________________________________________________________     _______________________________________
Signature of Witness                                                                                                                          Date

 

CONFIDENTIAL RECORD

 

_____________________________________________________________     _______________________________________
Employee Name (last, first, middle)                                                                                              DOB

Job Title:  _____________________________________________________________     

     Hepatitis B Vaccination Date           Lot Number                 Site                       Administered By
1  ________________________         ____________          ___________         _____________________________________
2  ________________________         ____________          ___________         _____________________________________
3  ________________________         ____________          ___________         _____________________________________

Additional Hepatitis B status information:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
 

_____________________________________________________________     _______________________________________
Provider Signature                                                                                                                            Date

 

 

CONFIDENTIAL RECORD

_____________________________________________________________     _______________________________________
Employee Name (last, first, middle)                                                                                              DOB

Job Title:  _____________________________________________________________     

Post-exposure incident:  (Date, time, circumstances, route under which exposure occurred)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
 

Identification and documentation of source individual:
____________________________________________________________________________________________________

Source blood testing consent:
____________________________________________________________________________________________________

Description of employee's duties as related to the exposure incident:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

Copy of information provided to health care professional evaluating an employee after an exposure incident:
____________________________________________________________________________________________________
____________________________________________________________________________________________________

Attach a copy of all results of examinations, medical testing, follow-up procedures, and health care professional's written opinion.
____________________________________________________________________________________________________

Comments/Plan
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
 

_____________________________________________________________     _______________________________________
Provider Signature                                                                                                                               Date

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:12

403.3R1 - Universal Precautions Regulation

403.3R1 - Universal Precautions Regulation

Universal precautions (UP) are intended to prevent transmission of infection, as well as decrease the risk of exposure for employees and students.  It is not currently possible to identify all infected individuals, thus precautions must be used with every individual.  UP pertain to blood and other potentially infectious materials (OPIM) containing blood.  These precautions do not apply to other body fluids and wastes (OBFW) such as saliva, sputum, feces, tears, nasal secretions, vomitus and urine unless blood is visible in the material.  However, these OBFW can be sources of other infections and should be handled as if they are infectious.  The single most important step in preventing exposure to and transmission of any infection is anticipating potential contact with infectious materials in routine as well as emergency situations.  Based on the type of possible contact, employees and students should be prepared to use the appropriate precautions prior to the contact.  Diligent and proper hand washing, the use of barriers, appropriate disposal of waste products and needles, and proper decontamination of spills are essential techniques of infection control.  All individuals should respond to situations practicing UP followed by the activation of the school response team plan.  Using common sense in the application of these measures will enhance protection of employees and students.

Hand Washing

Proper hand washing is crucial to preventing the spread of infection.  Textured jewelry on the hands or wrists should be removed prior to washing and kept off until completion of the procedure and the hands are rewashed.  Use of running water, lathering with soap and using friction to clean all hand surfaces is key.  Rinse well with running water and dry hands with paper towels.

  • Hands should be washed before physical contact with individuals and after contact is completed.
  • Hands should be washed after contact with any used equipment.
  • If hands (or other skin) come into contact with blood or body fluids, hands should be washed immediately before touching anything else.
  • Hands should be washed whether gloves are worn or not and, if gloves are worn, after the gloves are removed.

Barriers

Barriers anticipated to be used at school include disposable gloves, absorbent materials and resuscitation devices.  Their use is intended to reduce the risk of contact with blood and body fluids as well as to control the spread of infectious agents from individual to individual.  Gloves should be worn when in contact with blood, OPIM or OBFW.  Gloves should be removed without touching the outside and disposed of after each use.

Disposal of Waste

Blood, OPIM, OBFW, used gloves, barriers and absorbent materials should be placed in a plastic bag and disposed of in the usual procedure.  When the blood or OPIM is liquid, semi-liquid or caked with dried blood, it is not absorbed in materials, and is capable of releasing the substance if compressed, special disposal as regulated waste is required.  A band-aid, towel, sanitary napkin or other absorbed waste that does not have the potential of releasing the waste if compressed would not be considered regulated waste.  It is anticipated schools would only have regulated waste in the case of a severe incident.  Needles, syringes and other sharp disposable objects should be placed in special puncture-proof containers and disposed of as regulated waste.  Bodily wastes such as urine, vomitus or feces should be disposed of in the sanitary sewer system.

Clean up

Spills of blood and OPIM should be cleaned up immediately.  The employee should:

  • Wear gloves.
  • Clean up the spill with paper towels or other absorbent material.
  • Use a solution of one part household bleach to one hundred parts of water (1:100) or other EPA-approved disinfectant and use it to wash the area well.
  • Dispose of gloves, soiled towels and other waste in a plastic bag.
  • Clean and disinfect reusable supplies and equipment.

Laundry

Laundry with blood or OPIM should be handled as little as possible with a minimum of agitation.  It should be bagged at the location.  If it has the potential of releasing the substance when compacted, regulated waste guidelines should be followed.  Employees who have contact with this laundry should wear protective barriers.

Exposure

An exposure to blood or OPIM through contact with broken skin, mucous membrane or by needle or sharp stick requires immediate washing, reporting and follow-up.

  • Always wash the exposed area immediately with soap and water.
  • If a mucous membrane splash (eye or mouth) or exposure of broken skin occurs, irrigate or wash the area thoroughly.
  • If a cut or needle stick injury occurs, wash the area thoroughly with soap and water.

The exposure should be reported immediately, the parent or guardian is notified, and the person exposed contacts a physician for further health care.

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:30

403.04 - Hazardous Chemical Disclosure

403.04 - Hazardous Chemical Disclosure

The board authorizes the development of a comprehensive hazardous chemical communication program for the school district to disseminate information about hazardous chemicals in the workplace.

Each employee will annually review information about hazardous substances in the workplace.  When a new employee is hired or transferred to a new position or work site, the information and training, if necessary, will be included in the employee's orientation.  When an additional hazardous substance enters the workplace, information about it will be distributed to all employees, and training will be conducted for the appropriate employees.  The superintendent will maintain a file indicating which hazardous substances are present in the workplace and when training and information sessions take place.

Employees who will be instructing or otherwise working with students will disseminate information about the hazardous chemicals with which they will be working as part of the instructional program. 

It will be the responsibility of the superintendent to develop administrative regulations regarding this program. 

 

 

Legal Reference:          29 C.F.R. Pt. 1910; 1200 et seq.

                                    Iowa Code chs. 88; 89B.

                                   

Cross Reference:          403      Employees' Health and Well-Being

                                    804      Safety Program

 

 

Approved 11/1/2004                             Reviewed 11/19/2007                           Revised 05/16/2022

                                                                             11/21/2011

                                                                             11/21/2016

                                                                             05/16/2022

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:34

403.6 - Substance-Free Workplace

403.6 - Substance-Free Workplace

 

The board expects the school district and its employees to remain substance free.  No employee will unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana or any other controlled substance or alcoholic beverage as defined by federal or state law.  "Workplace" includes school district facilities, school district premises or school district vehicles.  "Workplace" also includes nonschool property if the employee is at any school-sponsored, school-approved or school-related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school business.

If an employee is convicted of a violation of any criminal drug offense committed in the workplace, the employee will notify the employee's supervisor of the conviction within five days of the conviction.

The superintendent will make the determination whether to require the employee to undergo substance abuse treatment or to discipline the employee.  An employee who violates the terms of this policy may be subject to discipline up to and including termination.  If the employee fails to successfully participate in a program, the employee may be subject to discipline up to and including termination. 

The superintendent will be responsible for publication and dissemination of this policy to each employee.  In addition, the superintendent will oversee the establishment of a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment programs.

It is the responsibility of the superintendent to develop administrative regulations to implement this policy.

 

 

Legal Reference:          41 U.S.C. §§ 701-707 (1994).

                                    42 U.S.C. §§ 12101 et seq. (1994).

                                    34 C.F.R. Pt. 85 (2002).

                                    Iowa Code §§ 123.46; 124; 279.8 (2003).

 

 

Cross Reference:          404      Employee Conduct and Appearance

 

Approved 11/1/2004                             Reviewed 11/19/2007                           Revised 01/23/2017

                                                                             11/21/2011                                            05/16/2022

                                                                             05/16/2022

 

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:36

403.6E1 - Substance-Free Workplace Notice to Employees

403.6E1 - Substance-Free Workplace Notice to Employees

EMPLOYEES ARE HEREBY NOTIFIED it is a violation of the Substance-Free Workplace policy for an employee to unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana or any other controlled substance or alcohol, as defined in Schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation at 21 C.F.R. 1300.11 through 1300.15 and Iowa Code Chapter 204.

"Workplace" is defined as the site for the performance of work done in the capacity as an employee.  This includes school district facilities, other school premises or school district vehicles.  Workplace also includes nonschool property if the employee is at any school-sponsored, school-approved or school-related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school business.

The superintendent retains the discretion to discipline an employee for violation of the Substance-Free Workplace policy.  If the employee fails to successfully participate in such a program, the employee may be subject to discipline up to and including termination.

EMPLOYEES ARE FURTHER NOTIFIED it is a condition of their continued employment that they comply with the above policy of the school district and will notify their supervisor of their conviction of any criminal drug statute for a violation committed in the workplace, no later than five days after the conviction.

 

SUBSTANCE-FREE WORKPLACE ACKNOWLEDGMENT FORM

I, ____________________________________, have read and understand the Substance-Free Workplace policy.  I understand that if I violate the Substance-Free Workplace policy, I may be subject to discipline up to and including termination.  If I fail to successfully participate in a substance abuse treatment program, I understand I may be subject to discipline up to and including termination.  I understand that if I am required to participate in a substance abuse treatment program and I refuse to participate, I may be subject to discipline up to and including termination.  I also understand that if I am convicted of a criminal drug offense committed in the workplace, I must report that conviction to my supervisor within five days of the conviction.

 

_______________________________________________________________________     _____________________________________
(Signature of Employee)                                                                                                                                            (Date)

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:38

403.6R1 - Substance-Free Workplace Regulation

403.6R1 - Substance-Free Workplace Regulation

A superintendent who suspects an employee has a substance abuse problem will follow these procedures:

         1.      Identification - the superintendent will document the evidence the superintendent has which leads the superintendent to conclude the employee has violated the Substance-Free Workplace policy.  After the superintendent has determined there has been a violation of the Substance-Free Workplace policy, the superintendent will discuss the problem with the employee.  The superintendent will also contact Law Enforcement and ask that they do an investigation into this incident.

         2.      Discipline - if, after the discussion with the employee, the superintendent determines there has been a violation of the Substance-Free Workplace policy, the superintendent may recommend discipline up to and including termination.  Participation in a substance abuse treatment program is voluntary.

         3.      Conviction - if an employee is convicted of a criminal drug offense committed in the workplace, the employee must notify the employer of the conviction within five days of the conviction.

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:40

403.7 - Drug and Alcohol Testing Program

403.7 - Drug and Alcohol Testing Program

Employees who operate school vehicles classified as “commercial motor vehicles” by the U.S. Department of Transportation, and are required to possess a commercial driver’s license (CDL) to operate those vehicles, are subject to drug and alcohol testing.  A “commercial motor vehicle” is a vehicle that transports sixteen or more persons including the driver or has a gross vehicle weight rating (GVWR) of 26,001 pounds or more.  For purposes of the drug and alcohol testing program, the term “employees” includes applicants who have been offered a position to operate a commercial motor vehicle owned by the school.

Employees or employee applicants that will operate a school vehicle as described above are subject to pre-employment drug testing prior to being allowed to perform a safety sensitive function using the school vehicle.  In addition, employees will be subject to random, reasonable suspicion and post-accident drug and alcohol testing at the expense of the employer.  Employees operating school vehicles will not perform a safety-sensitive function within four hours of using alcohol.  Employees governed by this policy are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate school vehicles and continue to be subject to the drug and alcohol testing program as long as they may be required to perform a safety-sensitive function as it is defined in the administrative regulations.  Employees with questions about the drug and alcohol testing program may contact the school district superintendent, 1207 1st Street West (319) 334-7400, transportation director, 1812 Mustang Way Dr (319) 334-7435 and/or school nurse, 1103 1st Street West (319) 334-7425, Independence, IA 50644.

Employees who violate the terms of this policy may be subject to discipline up to and including termination at the discretion of the school district.  The district is required to keep a record of all drug or alcohol violations by employees for a minimum of five years.  Employees are put on notice that information related to drug or alcohol violations will be reported to the Federal Motor Carrier Safety Administration (FMCSA) Clearinghouse.  Additionally, the district will conduct FMCSA Clearinghouse queries for employees annually.  Employees must provide written consent for the district to conduct FMCSA Clearinghouse queries; however, employees who choose to withhold consent will be prohibited from performing any safety sensitive functions.

It is the responsibility of the superintendent to develop administrative regulations to implement this policy in compliance with the law.  The superintendent will inform applicants of the requirement for drug and alcohol testing in notices or advertisements for employment.

The superintendent will also be responsible for publication and dissemination of this policy and its supporting administrative regulations and forms to employees operating school vehicles.  The superintendent will also oversee a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment resources and programs.

IASB Drug and Alcohol Testing Program (IDATP) Web site: 
https://www.ia-sb.org/Main/Affiliated_Programs/Iowa_Drug_Alcohol_Testing_Program.aspx.

 

 

Legal Reference:  American Trucking Association, Inc., v. Federal Highway Administration, 51 Fed. 3rd 405 (4th Cir. 1995).
  
                                    49 U.S.C. §§ 5331 et seq.
  
                                    42 U.S.C. §§ 12101
 
                                    41 U.S.C. §§ 81
  
                                    49 C.F.R. Pt. 40; 382; 391.
  
                                    34 C.F.R. Pt. 85
  
                                    Local 301, Internat'l Assoc. of Fire Fighters, AFL-CIO, and City of Burlington,
  
                                      PERB No. 3876 (3-26-91).
  
                                    Iowa Code §§ 124; 279.8; 321.375(2); 730.5

Cross Reference:  403.6   Substance-Free Workplace
  
                                    409.2   Employee Leave of Absence

Approved 11/1/2004                             Reviewed 11/19/2007                           Revised 10/22/2005  
                                                                                  11/21/2011                                       01/23/2017
                                                                                  09/21/2020                                         09/21/202

                                                                                  05/16/2022

                                                                                     

dawn.gibson.cm… Mon, 02/15/2021 - 11:41

403.7E1 - Drug and Alcohol Testing Program Notice to Employees

403.7E1 - Drug and Alcohol Testing Program Notice to Employees

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE HEREBY NOTIFIED they are subject to the school district's drug and alcohol testing program for pre-employment drug testing and random, reasonable suspicion and post-accident drug and alcohol testing as outlined in the Drug and Alcohol Testing Program policy, its supporting documents and the law.

Employees who operate school vehicles classified as “commercial motor vehicles” by the U.S. Department of Transportation are subject to drug and alcohol testing.  A “commercial motor vehicle” is a vehicle that transports sixteen or more persons including the driver or has a gross vehicle weight rating (GVWR) of 26,001 pounds or more.  For purposes of the drug and alcohol testing program, “employees” also includes applicants who have been offered a position to operate a commercial motor vehicle owned by the school.  Employees that will operate a school-owned commercial motor vehicle are subject to the drug and alcohol testing program regulations beginning the first day they are offered a position to operate a school vehicle and continue to be subject to the drug and alcohol testing program until such time employment is terminated or the employee will no longer operate, at any time, a commercial motor vehicle for the school.

It is the responsibility of the superintendent to inform employees of the drug and alcohol testing program requirements.  Employees with questions regarding the drug and alcohol testing requirements will contact the transportation director, 1812 Mustang Way Dr (319) 334-7435 and/or school nurse, 1103 1st Street West            (319) 334-7425, Independence, IA 50644.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that employees violating this policy, its supporting documents or regulations will be subject to discipline up to and including termination.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED that information related to drug or alcohol violations will be reported to the Federal Motor Carrier Safety Administration (FMCSA) Clearinghouse.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE FURTHER NOTIFIED it is a condition of their continued employment to comply with the Drug and Alcohol Testing Program policy, its supporting documents, regulations and the law.  It is a condition of continued employment for employees operating a school vehicle to notify their supervisor of any prescription medication they are using.  Drug and alcohol testing records about a driver are confidential and are released in accordance with this policy, its supporting documents, regulations or the law.

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:44

403.7E2 - Certification from Current Employer Participating in Drug & Alcohol Program

403.7E2 - Certification from Current Employer Participating in Drug & Alcohol Program

I, ______________________________________________________________ am currently employed by
                                               Name of Undersigned

 __________________________________________________________ who participates in the Drug and Alcohol
                                          Employer   

Program through ____________________________________________.  I consent to have my records pertaining                                                                                                              
                                       Drug & Alcohol Testing Provider

to drug and alcohol testing released to the Independence Community School District for the past 24 months of

employment.

_______________________________________________         _______________
(Signature)                                                                                                            (Date)

_______________________________________________         _______________
(Signature of Employer)                                                                                   (Date)

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:45

403.7E3 - Certification of Previous Employers Requiring a Commercial Driver’s License Consent to Release Information to Independence Community School District

403.7E3 - Certification of Previous Employers Requiring a Commercial Driver’s License Consent to Release Information to Independence Community School District

_________________________________________________         ______________________________________
                                 Name                                                                                     Social Security Number

 

I certify that I have been employed by the following employers during the two years prior to the date stated below and that I was required to possess a commercial driver’s license (CDL) and submit to drug and alcohol testing during the term of my employment.

 

Company  _____________________________________________________________________

Address  ______________________________________________________________________

City/State/Zip  _________________________________________________________________

 

Company  _____________________________________________________________________

Address  ______________________________________________________________________

City/State/Zip  _________________________________________________________________

 

Company  _____________________________________________________________________

Address  ______________________________________________________________________

City/State/Zip  _________________________________________________________________

 

I hereby release my records pertaining to my driving and drug and alcohol testing results.

 

_________________________________________________     ______________________________
(Signature)                                                                                                              (Date)

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:48

403.7E4 - Drug and Alcohol Testing Program Acknowledgement Form

403.7E4 - Drug and Alcohol Testing Program Acknowledgement Form

I, ( ______________________________________________________ ), have received a copy, read and
                                         Name of Employee

understand the Drug and Alcohol Testing Program policy and its supporting documents.  I have also read and

understand the “Drug and Alcohol Training Handbook” provided to me by the district.  I consent to submit to the

drug and alcohol testing program as required by the Drug and Alcohol Testing Program policy, its supporting

documents, regulations and the law.

I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents, regulations

or the law, I may be subject to discipline up to and including termination.

I also understand that I must inform my supervisor of any prescription medication I use when requested.  I further

understand that drug and alcohol testing records about me are confidential and may be released in accordance with

this policy, its supporting documents, regulations or the law.

 

_______________________________________________     _____________________________
(Signature of Employee)                                                                                      (Date)

_______________________________________________     _____________________________
(Witness/Transportation Director)                                                                       (Date)

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:52

403.7E5 - Drug and Alcohol Reasonable Suspicion Observation Form

403.7E5 - Drug and Alcohol Reasonable Suspicion Observation Form

This form must be completed by each trained employee observing the driver suspected of drug use and/or alcohol

misuse by behavior, speech and/or odor while on duty, the earlier of within 24 hours or the determination of reasonable suspicion or prior to receiving the test results.   The observations must be specific, contemporaneous and articulable concerning the appearance, behavior, speech and body odor of the driver.

An example of an appropriate observation statement is, “The driver entered the bus barn slowly and held onto the bus until the driver reached the bus door,” rather than, “The driver came to work stoned and could not walk without holding onto the bus for support.”

Employees must notify the director of transportation about the situation.  The director of transportation will notify the superintendent and they will contact law enforcement to assist with the investigation.

 

 

_____________________________________________                         ________________________
                           Employee’s Name                                                                Date of Observation

Time of Observation:   From __________ a.m./p.m. to __________ a.m./p.m.

Location:  ______________________________________________________________

Observed personal behavior:  (check all appropriate items)

Speech:                                                                        ___Normal       ___Incoherent    ___Confused  

                                                                              ___Slurred       ___Whispering ___Silent

Balance:                                                                          ___Normal          ___Swaying

                                                                               ___Staggering  ___Falling       

 

Walking and Turning:                                                       ___Normal       ___Stumbling     ___Swaying

                                                                        ___Arms raised for balance         ___Reaching for support

 

Awareness:                                                                  ___Normal       ___Confused      ___Paranoid

                                                                            ___Sleepy or stupor   ___Lack of coordination

 

Odor:                                                                                  ___Normal       ___Alcohol        ___Burned rope

Other observed behavior/odor:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

 

Reasonable suspicion of current use or impaired by:       ___Alcohol      ___Drugs

 

Above behavior witnessed by:

_____________________________________________                         ________________________
                           (Signature)                                                                                                (Date)

_____________________________________________                         ________________________
                           (Signature) (optional)                                                                                (Date)

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:54

403.7E6 - Drug and Alcohol Program and Pre-Employment Testing written Consent to Share Information

403.7E6 - Drug and Alcohol Program and Pre-Employment Testing written Consent to Share Information

I, (   Name of Employee___   ), understand that as part of my employment in a position that requires a commercial driver’s license in the Independence Community School District, I grant consent for the District to conduct queries of the Federal Motor Carrier Safety Administration (“FMCSA”) Commercial Driver’s License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse.  I further consent to the District sharing information related to my drug and alcohol testing results with prior, current and future employers, as well as the FMCSA Clearinghouse in accordance with state and federal laws. 

I understand that the District will check and perform queries of my drug and alcohol testing results prior to my employment in any position which requires the use of a commercial driver’s license.  I further understand the District will check and perform queries of my testing results annually and is required to report any drug and alcohol violations of this policy to the FMCSA Clearinghouse. 

I understand that I am not required to consent to the query of the FMCSA Clearinghouse or the District sharing of drug and alcohol testing information with past, present or future employers or the FMCSA Clearinghouse; but that without my consent I understand I will be prohibited from performing safety sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations. 

I hereby give my consent to the District to perform queries of the FMCSA Clearinghouse and share my drug and alcohol testing results with past, present and future employers, as well as the FMCSA Clearinghouse.

 

__________________________________________________               ________________________
(Signature of Employee)                                                                                      (Date)

 

dawn.gibson.cm… Mon, 02/15/2021 - 11:59

403.7R1 - Drug and Alcohol Testing Program

403.7R1 - Drug and Alcohol Testing Program

PRE-EMPLOYMENT PROCEDURES FOR BUS DRIVERS

All advertisements must include a statement that explains the position of a driver in the Independence Community School District is subject to drug and alcohol testing to include pre-employment testing.  Should the potential employee already be under a recognized or approved Department of Transportation (D.O.T.) testing program, the pre-employment testing may be waived at the discretion of the superintendent/designee.  The potential employee must provide proof of participation in such a program (403.7E2).  A potential employee that is not currently under another approved testing program must consent to release any and all drug and alcohol related information records (403.7E3) from any previous employer dating back 24 months as well as be subject to pre-employment testing.

All potential drivers will be given training on controlled substances and alcohol use by the transportation director prior to being eligible for driving duties.  This training will consist of a self study of the “Drug and Alcohol Training Handbook” developed by the D.O.T.  Upon completion of this self study, the potential employee will sign off on the Drug and Alcohol Acknowledgement Form (403.7E4) in the presence of the transportation director that they have read and understand the contents of the handbook.  The transportation director will receive all acknowledgement forms and maintain a confidential file on the drug and alcohol testing program for each employee under this program.  Records will be maintained for a minimum of five years.

The transportation director will coordinate all testing with an approved D.O.T. provider.  Should a potential employee test positive or they have refused to any part of the above, mentioned procedures, they will not be considered for employment.

 

EMPLOYMENT PROCEDURES FOR BUS DRIVERS

All bus drivers are subject to random testing at any time throughout the calendar year.  Quarterly random testing will be done.  Should a bus driver be involved in an accident while operating a school vehicle (CMV), the school district will test each surviving driver for alcohol and controlled substances when either:

  • The accident involved a FATALITY; or
  • The driver RECEIVED A CITATION under state or local law for a moving traffic violation arising from the accident, and either ONE or BOTH of the following OCCURRED in the accident:
    1. Bodily injury requiring immediate medical treatment away from the scene.
    2. One or more of the motor vehicles incurred disabling damage requiring it to be towed from the scene by another motor vehicle or tow truck.

 

REASONABLE SUSPICION

Should a bus driver’s behavior be questioned as potentially being under the influence, it is recommended that there be two witnesses to the behavior, but it is not required.  When considering reasonable suspicion, only the transportation director/designee is authorized to request the test be administered. It is important to note that only those who have received the U.S. D.O.T. training may request this test.  A driver can be notified for a reasonable suspicion test only just before, during, or just after performing a safety sensitive function (within 30 minutes).  When it is believed reasonable suspicion exists, it is important to meet with the driver in private and document the observations leading to the reasonable suspicion test (403.7E5).  Upon completion of the meeting, the transportation director may notify the program provider for a test to be administered.  Failure by the employee to submit to the test will be considered grounds for termination with the Independence Community School District.

 

dawn.gibson.cm… Mon, 02/15/2021 - 12:00