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April 18, 2011 (Regular Meeting) Page <br />Unusual Actions: _Belching _Vomiting _Fighting _Accident Prone <br />_Crying _Laughing _Runny Nose _None <br />Walking and Turning: Stumbling Swaying _Staggering _Arms Raised <br />for Balance _Falling Reaching for Support Feet Wide Apart <br />Unable to Stand Normal <br />Awareness: _Sleepy or Stupor _Lack of Coordination _Confused <br />Paranoid Normal <br />OBSERVATION OF SUSPECT BEHAVOR (continued) <br />Indicate other unusual actions or statements, including when first observed: <br />Were your observations made during, just preceding, or just after the period <br />of the workday that the employee was performing covered functions? <br />Yes No <br />HISTORY <br />Number of Mondays missed or tardy in the last two months: <br />Has there been a recent change in the employee's level of performance? <br />Yes No Don't Know <br />SUPERVISOR' S OPINION <br />Indicate briefly what leads you to suspect drug and /or alcohol influence: <br />Indicate any additional substandard job performance: <br />Other Witnesses: <br />Date: <br />Supervisor's Signature <br />Date: <br />Supervisor- Witness' Signature <br />CONTACT THE HUMAN RESOURCES DIRECTOR AND FORWARD COMPLETED FORM TO HUMAN <br />RESOURCES <br />HR reviewed 4/20/2009 <br />FORM E <br />CABARRUS COUNTY GOVERNMENT <br />POST DRUG TEST NOTICE TO APPLICANT OR EMPLOYEE <br />DATE: <br />TO (applicant /employee): <br />The results for the test sample you provided on <br />show positive for a controlled substance. We were notified of the positive <br />result on <br />In accordance with 13 North Carolina Administrative Code 20.0402, this notice <br />explains your rights and responsibilities regarding retesting under North <br />Carolina General Statue 95- 232(f): <br />• You may request in writing, a retest of the above sample at the same or <br />other approved laboratory within ninety days of the date we were <br />notified of the results. <br />A -1 Page 295 <br />