Common use of Use of Employee's Time Clause in Contracts

Use of Employee's Time. Separate from any disciplinary action reference in this policy, should the employee be required to be out of work as a consequence of a course of treatment required for any violation of this policy, he/she shall first use any and all sick time available to him/her, then personal or compensatory time, then any unused vacation time. Any days necessary after that may be unpaid. Date Date Reasonable Suspicion Report Form Date: Time: Sign off Sheet I have read and/or have had explained to me, the Alcohol and Controlled Substances Testing Policy, as approved by the University of Massachusetts, Amherst and AFSCME Local 1776. PRINT NAME SIGNATURE DATE: Authorization for Release and Receipt of Information I, the undersigned, hereby authorize the Substance Abuse Professional to advise the Designated Employer Representative, in my respective work area, that I have entered a treatment program (start date), the approximate length I will be enrolled (end date) and when my return to duty test will be given and the results subsequently provided to my employer. I further understand that failure to execute this agreement will result in my immediate termination. Location of incident/accident: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Accident related injuries? Yes No (circle) If yes, provide details. -------------------------------------------------------------------------------------- Provide a brief summary of accident: -------------------------------------------------------------------------------------- Description of other party(s) involved: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Police at scene? Yes No (circle) If yes, provide jurisdiction: Employee's signature Employer Designated Representative Date Date Supervisor's Accident Report Name (Supervisor/Manager) Name (Supervisor/Manager) Date Date Date: Time: Location of incident

Use of Employee's Time. Separate from any disciplinary action reference in this policy, should the employee be required to be out of work as a consequence of a course of treatment required for any violation of this policy, he/she shall first use any and all sick time available to him/her, then personal or compensatory time, then any unused vacation time. Any days necessary after that may be unpaid. Date Date Reasonable Suspicion Report Form Date: Time: Sign off Sheet I have read and/or have had explained to me, the Alcohol and Controlled Substances Testing Policy, as approved by the University of Massachusetts, Amherst and AFSCME Local 1776. PRINT NAME SIGNATURE DATE: Authorization for Release and Receipt of Information I, the undersigned, hereby authorize the Substance Abuse Professional to advise the Designated Employer Representative, in my respective work area, that I have entered a treatment program (start date), the approximate length I will be enrolled (end date) and when my return to duty test will be given and the results subsequently provided to my employer. I further understand that failure to execute this agreement will result in my immediate termination. Employee's signature Employer Designated Representative -------------------------- Date Date Supervisor's Accident Report General Provisions for Alcohol and Drug Testing Payment of recommended programs may be covered by the employee's health insurance according to the terms set forth Date: Location of incidentincident Time: in his/accident: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- her policy. Deductibles and co-payments are the responsibility of the employee. If an employee has an Adulterated Alcohol/Drug Test (i.e. the specimen has been tampered with by the employee), it will be considered a refusal to test and shall be subject to the penalties the same as a positive test. ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- Accident related injuries? Yes No (circle) If yesI f y e s , provide details. -------------------------------------------------------------------------------------- _______ ___ _ Provide a brief summary of accident: -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- Description of other party(s) involved: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- Police at scene? Yes No (circle) If yesI f y e s , provide jurisdiction: Employee's signature Employer Designated Representative Date Date Supervisor's Accident Report Name (Supervisor/Manager) Name (Supervisor/Manager) Date Date Date: Time: Location of incident---------------------------------------------------------------------------------------

Use of Employee's Time. Separate from any disciplinary action reference in this policy, should the employee be required to be out of work as a consequence of a course of treatment required for any violation of this policy, he/she shall first use any and all sick time available to him/her, then personal or compensatory time, then any unused vacation time. Any days necessary after that may be unpaid. Date Date Reasonable Suspicion Report Form Date: Time: Sign off Sheet I have read and/or have had explained to me, the Alcohol and Controlled Substances Testing Policy, as approved by the University of Massachusetts, Amherst and AFSCME Local 1776. PRINT NAME SIGNATURE DATE: Authorization for Release and Receipt of Information I, the undersigned, hereby authorize the Substance Abuse Professional to advise the Designated Employer Representative, in my respective work area, that I have entered a treatment program (start date), the approximate length I will be enrolled (end date) and when my return to duty test will be given and the results subsequently provided to my employer. I further understand that failure to execute this agreement will result in my immediate termination. Location of incident/accident: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Accident related injuries? Yes No (circle) If yes, provide details. -------------------------------------------------------------------------------------- Provide a brief summary of accident: -------------------------------------------------------------------------------------- Description of other party(s) involved: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- Police at scene? Yes No (circle) If yesI f y e s , provide jurisdiction: Employee's signature Employer Designated Representative -------------------------- Date Date Supervisor's Accident Report Name (Supervisor/Manager) Name (Supervisor/Manager) Date Date Date: Time: Location of incident

Use of Employee's Time. Separate from any disciplinary action reference in this policy, should the employee be required to be out of work as a consequence of a course of treatment required for any violation of this policy, he/she shall first use any and all sick time available to him/her, then personal or compensatory time, then any unused vacation time. Any days necessary after that may be unpaid. Date Date Reasonable Suspicion Report Form Date: Time: Sign off Sheet SIGN OFF SHEET I have read and/or have had explained to me, the Alcohol and Controlled Substances Testing Policy, as approved by the University of Massachusetts, Amherst and AFSCME Local 1776. PRINT NAME SIGNATURE DATE: Authorization for Release and Receipt of Information AUTHORIZATION FOR RELEASE AND RECEIPT OF INFOMATION I, the undersigned, undersigned hereby authorize the Substance Abuse Professional to advise the Designated Employer Representative, Representative in my respective work area, area that I have entered a treatment program (start date), the approximate length I will be enrolled (end date) and when my return to duty test will be given and the results subsequently provided to my employer. I further understand that failure to execute this agreement will result in my immediate termination. Employee’s signature Employer Designated Representative Date Date SUPERVISOR’S ACCIDENT REPORT Date: Time: Location of incident/accident: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Accident related injuries? Yes No (circle) If yes, yes provide details. -------------------------------------------------------------------------------------- Provide a brief summary of incident/accident: -------------------------------------------------------------------------------------- Description of other party(s) involved: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Police at scene? Yes No (circle) If yes, yes provide jurisdiction: Employee's signature Employer Designated Representative Date Date Supervisor's Accident Report Name (Supervisor/Manager) Name (Supervisor/Manager) Date Date REASONABLE SUSPICION REPORT FORM Date: Time: Location of incident Related injuries? Yes No (circle) If yes provide details. Provide a brief summary of incident: Description of other party(s) involved: Police at scene? Yes No (circle) If yes provide jurisdiction: Name (Supervisor/Manager) Name (Supervisor/Manager) Date Date

Use of Employee's Time. Separate from any disciplinary action reference in this policy, should the employee be required to be out of work as a consequence of a course of treatment required for any violation of this policy, he/she shall first use any and all sick time available to him/her, then personal or compensatory time, then any unused Date Date Reasonable Suspicion Report Form vacation time. Any days necessary after that may be unpaid. Date Date Reasonable Suspicion Report Form Date: Time: Sign off Sheet I have read and/or have had explained to me, the Alcohol and Controlled Substances Testing Policy, as approved by the Date: Location of incident/accident: Time: University of Massachusetts, Amherst and AFSCME Local 1776. PRINT NAME SIGNATURE DATE: -------------------------------------------------------------------------------------- Accident related injuries? Yes No (circle) If yes, provide details. -------------------------------------------------------------------------------------- Authorization for Release and Receipt of Information I, the undersigned, hereby authorize the Substance Abuse Professional to advise the Designated Employer Representative, in my respective work area, that I have entered a treatment program (start date), the approximate length I will be enrolled (end date) and when my return to duty test will be given and the results subsequently provided to my employer. I further understand that failure to execute this agreement will result in my immediate termination. Location of incident/accident: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Accident related injuries? Yes No (circle) If yes, provide details. -------------------------------------------------------------------------------------- Provide a brief summary of accident: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Description of other party(s) involved: -------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- Police at scene? Yes No (circle) If yes, provide jurisdiction: Employee's signature Employer Designated Representative Date Date Supervisor's Accident Report -------------------------- Name (Supervisor/Manager) Name (Supervisor/Manager) Date Date Date Date: Time: Location of incident