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Office of Civil Rights Compliance Checklist <br />B. Drug -Free Workplace Yes No <br />19. <br />Does the agency have a Drug -Free Workplace policy in place? <br />20. <br />Who administers the Drug -Free Workplace Program? <br />Office or <br />Position Title: <br />21. <br />Do the provisions include: <br />• Counseling • Rehabilitation • Employee Assistance <br />22. <br />Do violations result in: <br />• Termination • Penalties • Rehabilitation <br />23. <br />Has any employee of the contractor, or its subcontractors/formal participants, <br />been convicted of a criminal drug offense on the job or premises, within the last <br />two years? <br />24. <br />Was COMMERCE (or Task Force lead agency) notified promptly (within 5 days, <br />BJA within 10 days of the conviction)? <br />25. <br />Was appropriate personnel action taken within 30 days? <br />Conflict of Interest <br />26. <br />Has any allegation or finding of Conflict of Interest been made against any <br />employee or official of the contractor, or its subcontractors/formal participants, in <br />relation to the grant within the last two years? <br />(Limit response to project's personnel, supervisors and policy chain) <br />27 <br />Was COMMERCE (or Task Force lead agency) notified promptly <br />(within 30 days; if actively investigated, after conclusion of the investigation)? <br />28. <br />Describe the allegation or finding <br />Certification: The undersigned certify that the above is a true representation of the Civil Rights and other issues covered by this checklist. <br />For (responding City, County, Tribal Jurisdiction, or Non -Governmental Entity): <br />Signature (of Human Resources/Personnel Respondent) <br />Name/Title of Respondent <br />Date <br />Signature (of grant activity coordinator (items 13,14,17 & 23-27)) <br />Name/Title of Respondent <br />Note: Project coordinator/liaison (right signature block) should respond to questions with color accented line numbers (13, 14, 17 & 23-27) <br />as in some jurisdictions these events are resolved between department heads and the executive council, and are not consistently <br />reported to Human Resources/Personnel. <br />Date <br />30 <br />