WORKPLACE DRUG AND ALCOHOL INCIDENT REPORT

This report form is for incidents related to drug and alcohol use within [Your Company Name]. It's crucial to document such occurrences to ensure workplace safety and compliance with company policies.

Instructions:

1. Accuracy: Provide accurate and factual details in each section.

2. Confidentiality: This report is confidential and should be shared only with authorized personnel.

3. Response and Follow-up: Use this report to inform necessary response actions and preventative strategies.

4. Support: For assistance, contact [Your Company's Human Resources or Health and Safety Department].

Submit to: [Designated Department or Individual] at [Your Company Name]. This information will be used for immediate action and policy reinforcement.

Incident Details

Section	Details
Date of Incident	[Month Day Year]
Time of Incident	[HH:MM AM/PM]
Location of Incident	[Workplace Location, e.g., Warehouse, Office]
Type of Incident	[Drug Use, Alcohol Intoxication, etc.]
Description of Incident	[Employee [Name] was found in an inebriated state during working hours in the warehouse area. A subsequent search revealed a hidden bottle of alcohol.]
Persons Involved	[Name - Employee, John Doe - Witness]
Witnesses	[Names of any witnesses, if applicable]

Immediate Actions Taken

Section	Details
Initial Response	[The employee was escorted to a safe area and HR was notified.]
Medical Assistance	[Name] was evaluated by on-site medical staff for health concerns.]
Incident Documentation	[Statements were taken from [Name] and witnesses.]

Follow-Up Actions Recommended

Section	Details
Disciplinary Action	[Consider appropriate disciplinary measures following company policy.]
Policy Review and Reinforcement	[Reiterate company policies on drug and alcohol use to all employees.]
Employee Assistance Program	[Offer support through an Employee Assistance Program (EAP) for substance abuse issues.]

Report Submission:

Submitted To: ______________________[Name/Department]

Submission Date: ___________________[Month Day Year]

Signature of Reporting Individual: ____________________

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