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August 31, 2016
Drug- and alcohol-free workplace return-to-work agreement

When workers return from treatment for drug- and alcohol-related issues that violated drug- and alcohol-related workplace policies, you may want to have them sign an agreement outlining the expectations affecting both the employer and the worker, as well any consequences for violating the agreement.

This sample return-to-work agreement is adapted from one prepared by the U.S. Department of Labor.

Sample return-to-work agreement

This return-to-work agreement is between (company name) (the employer) and (employee name) (the employee). This agreement is necessary because the employee has violated a work rule that could result in termination: (list the work rule/rules violated)

The employee has received a copy of the employer’s drug- and alcohol-free workplace policy and understands all of the provisions of the policy. The employee agrees to abide by its provisions.

The employee has voluntarily signed a release allowing the employer to receive information from medical professionals regarding the employee’s continuing care recommendations and compliance. The employee agrees to abide by all of the medical professionals’ recommendations. The employee will document mandatory attendance at appointments and other required appearances. The employee understands and agrees that the employer will monitor compliance with the medical professionals’ recommendations. The employee agrees to be subject to unannounced follow-up testing for a period of (list time period).

The employee agrees to abstain from the use of all alcohol and other drugs except as prescribed by a physician who is aware of the employee’s history of substance abuse.

The employee agrees that any costs for treatment and monitoring that are not covered by the employer’s insurance plan are the responsibility of the employee.

If the employee must miss work to attend required appointments, the missed work time will be treated as family and medical leave, sick leave, vacation, or personal leave as available and appropriate.

The employee understands this is a “last chance” to successfully comply with the employer’s drug- and alcohol-free workplace policy. The employee understands that failure to fully comply with this agreement will result in immediate termination.

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