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APPLICATION FORM -INSTRUCTIONS FOR COMPLETING

The opportunity to participate in this pilot project is available to all owners, employers, employer associations and labour providers in the oil sands operations and maintenance, industrial construction and maintenance, and related industriesin Alberta that choose to participate.

Forms are to be completed at www.darrpp.ca. If you have questions please contact Pat Atkins at pmatkins@shaw.ca or 403-466-8090.

Contact Information:

Contact information should be provided for the individual(s) who will be responsible for oversight of the organizations A&D program. This person will be contacted for information regarding the application, ongoing data collection and evaluation and audit questions, as the pilot progresses.

Scope of participation:

Indicate what sites or locations, in your Canadian operations, will be included in the pilot. Some organizations may choose to include only their employees/operations in Alberta or in a particular region.

Key components of your policy:

Provide a brief description of the key components of your A&D policy. Just a paragraph or two is enough, then attach a copy of your policy. The key aspects you should describe are: A&D testing that you do and under what circumstances, who is covered by your policy, outcomes of various testing results.

Positions to be included:

Indicate which positions will be included in the random testing component of your policy. This could include management positions as well as safety sensitive positions. Please indicate the actual or approximate numbers of people you expect will be included and a description of the types of positions to be included (eg. all trades and operations, managers and up, all supervisors of safety sensitive employees). There is a separate question regarding contractors, so you can provide that information as part of that question.

Testing process:

Describe the testing process and device you will use (oral fluid, urine), and whether testing will be done by a third party (and which company) or internally.

Assessment, case management and return to work:

Describe the process you will use to assess workers with confirmed positive tests to determine if they have a disability or not, and who will do the assessments. Indicate your case management process – including what you will do with workers with a confirmed disability in terms of treatment, follow-up, return to work and who will handle these processes.

EAP and treatment program:

Indicate who your EAP provider is and what services are provided regarding assistance with A&D issues and treatment for employees who seek assistance on their own or who are referred. Specifically describe what occurs regarding treatment for workers who test positive at work.

Privacy controls:

Describe who has access to A&D testing information, and what controls you have in place to ensure that access to A&D program info is limited. Also indicate what controls are in place to ensure your employees do not have access to contractor A&D testing information.

Contractors:

Describe your plans relative to contractors. It is assumed that owner companies will require contractors to implement the pilot for workers on their site – please indicate if this is the case, and if not, what you plan to do.