WA ST Dept of Commerce 10/15/2021

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