PLUMBING, PIPING, AND REFRIGERATION INDUSTRY
DRUG FREE WORKPLACE PROGRAM, INC.
3667 West 1987 South, Bldg 6
Salt Lake City, UT 84104
CODA Testing Website
Blomquist Hale Employee Assistance Provider
860 East 4500 South
Salt Lake City, UT 84107
Blomquist Hale Employee Assistance Program Website
- Acknowledgement of Receipt and Consent to DFW Program Form – This form must be completed by all of the employees under the program.
- Adoption by Employer Form – Each employer company must sign this form to acknowledge that this program has been adopted by the company.
- Authorized Representatives Form – Each company covered under the Drug Free Workplace Program must designate two authorized representatives to oversee the DFW Program for their company. Please fill out this form and return to Carrie Francis.
- Collection Sites List – This is a list of all the approved collection sites under the policy. If you use a collection site not on thCollection Sites Listis list, but would like to request it be added, please contact Dr. Paul Teynor at firstname.lastname@example.org to request the approval of the collection site. Please note that it may be the case that not all collection sites will be approved and added to the list.
- Non-Bargained Employees Form – For each company not covered by the Utah Pipe Trades Health and Welfare Benefit. Companies not covered under the UPT H&W Benefit will need to complete this form with all of the names and employee ID numbers of all of the office employees of their company. If a company is already doing this under the Sheet Metal DFW Program, please let the UMCA know, and we will not need to have you test in both programs.
- Reasonable Suspicion Record – This form must be completed by supervisors and/or managers to request a Reasonable Cause of For Cause drug and/or alcohol test.