BC 2011 04 18 Regular - Laserfiche WebLink

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April 18, 2011 (Regular Meeting) Page 392 Unusual Actions: _Belching _Vomiting _Fighting Accident Prone _Crying _Laughing _Runny Nose _None Walking and Turning: Stumbling Swaying _Staggering Arms Raised for Balance _Falling _Reaching for Support _Feet Wide Apart Unable to Stand Normal Awareness: _Sleepy or Stupor _Lack of Coordination _Confused Paranoid Normal OBSERVATION OF SUSPECT BEHAVOR (continued) Indicate other unusual actions or statements, including when first observed: Were your observations made during, just preceding, or just after the period of the workday that the employee was performing covered functions? Yes No HISTORY Number of Mondays missed or tardy in the last two months: Has there been a recent change in the employee's level of performance? Yes No Don't Know SUPERVISOR' S OPINION Indicate briefly what leads you to suspect drug and /or alcohol influence: Indicate any additional substandard job performance: Other Witnesses: Date: Supervisor's Signature Date: Supervisor- Witness' Signature CONTACT THE HUMAN RESOURCES DIRECTOR AND FORWARD COMPLETED FORM TO HUMAN RESOURCES HR reviewed 4/20/2009 FORM E CABARRUS COUNTY GOVERNMENT POST DRUG TEST NOTICE TO APPLICANT OR EMPLOYEE DATE: TO (applicant /employee): The results for the test sample you provided on show positive for a controlled substance. We were notified of the positive result on In accordance with 13 North Carolina Administrative Code 20.0402, this notice explains your rights and responsibilities regarding retesting under North Carolina General Statue 95- 232(f): • You may request in writing, a retest of the above sample at the same or other approved laboratory within ninety days of the date we were notified of the results.