WORKPLACE DRUG AND ALCOHOL INCIDENT REPORT

This report form is for incidents related to drug and alcohol use within [Your Company Name]. It's crucial to document such occurrences to ensure workplace safety and compliance with company policies.

Instructions:

1. Accuracy: Provide accurate and factual details in each section.
2. Confidentiality: This report is confidential and should be shared only with authorized personnel.
3. Response and Follow-up: Use this report to inform necessary response actions and preventative strategies.
4. Support: For assistance, contact [Your Company's Human Resources or Health and Safety Department].

Submit to: [Designated Department or Individual] at [Your Company Name]. This information will be used for immediate action and policy reinforcement.

Incident Details

Section

Details

Date of Incident

Time of Incident

Location of Incident

[Workplace Location, e.g., Warehouse, Office]

Type of Incident

[Drug Use, Alcohol Intoxication, etc.]

Description of Incident

[Employee [Name] was found in an inebriated state during working hours in the warehouse area. A subsequent search revealed a hidden bottle of alcohol.]

[Name - Employee, John Doe - Witness]

[Names of any witnesses, if applicable]

Immediate Actions Taken

Section

Details

[The employee was escorted to a safe area and HR was notified.]

[Name] was evaluated by on-site medical staff for health concerns.]

[Statements were taken from [Name] and witnesses.]

Follow-Up Actions Recommended

Section

Details

[Consider appropriate disciplinary measures following company policy.]

Policy Review and Reinforcement

[Reiterate company policies on drug and alcohol use to all employees.]

Employee Assistance Program

[Offer support through an Employee Assistance Program (EAP) for substance abuse issues.]

Report Submission:

Submitted To: ______________________[Name/Department]

Submission Date: ___________________[Month Day Year]

Signature of Reporting Individual: ____________________

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