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Supervisor Acknowledgment Form

 

I, _____________________________________________ hereby acknowledge receipt of the Power Tech Industries Alcohol and Drug Policy and Procedures.

I acknowledge that I have read and understand the policy and procedures and agree to enforce the standards herein contained as part of my job responsibilities and accountability as a Supervisor.

I understand that a high standard of confidentiality is required when dealing with issues related to chemical dependency and forthwith agree to maintain the confidentiality of all persons involved with the administration of this policy and procedure.

I agree to comply with the Alcohol and Drug Policy and Procedures and understand that non-compliance can result in disciplinary action up to and including termination and suspension from re-hire for an indefinite period.

 

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Supervisor Signature                                      Print

 

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Senior Manager Signature                              Print

 

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Date:                                                              Company Name