Human Resources Business Partner

DRUG AND ALCOHOL-FREE WORKPLACE POLICY ACKNOWLEDGMENT

By my signature below, I acknowledge that I have received a copy of INTEGRIS Health’s Drug and Alcohol-Free Workplace Policy (SYS-HR-609) and understand all of the following:

• I am obligated to read and comply with this policy as a condition of employment.

• I may be subject to drug and alcohol testing in the as outlined in the policy, including pre- employment, for cause whenever there is reasonable belief of impairment, transfer or reassignment into a patient care role, following workplace accident, and upon return to work following leave in certain circumstances.

• Testing positive or refusal to submit to testing is grounds for INTEGRIS Health to rescind my offer of employment or terminate my employment as the case may be. Leaving prior to completion of health screening will result in my being ineligible for hire for 12 months.

• Should I have any questions about this policy, I should contact my leader, assigned Human Resources business partner or Caregiver Health.

X X Caregiver Signature Date

X

Print name

X X Signature of parent or guardian if caregiver a minor. Date