Unsafe Practice. Poor behavior or judgment on the part of an Employee which, in the opinion of a supervisor / manager, could have caused or contributed to an accident as defined above. FORM D-7 LIBERTY TOWNSHIP’S PARTICIPATION / WORK ACCOMMODATION AGREEMENT On this day of , , the Township and (also referred to herein as “I”) agreed that I have sought or will be seeking an assessment from and / or a referral to a treatment program for alcohol and / or drug abuse. This agreement does not alter terms and conditions of employment as specified in the collective bargaining agreement (if applicable). The following conditions will apply: Assessment has been scheduled. Appointment Date: Appointment Time: You are to make the appointment and report within 48 hours the following: Counselor’s Name: Telephone Number: Appointment Date: Appointment Time:
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