To register: Please mail this registration form at least a week in advance to: Sanford Health Workplace Drug Analysis Services PO Box 2010, Route #2230 Fargo, ND 58122-2230 Fax: (701) 234-2917 or email: [email protected] with the following information Sanford Health Occupational Medicine Business name:_____________________________ Drug & alcohol awareness in the workplace Contact name:______________________________ Address:___________________________________ City, State, Zip:______________________________ Telephone:_________________________________ Names of employees attending: (print) __________________________________________ __________________________________________ __________________________________________ __________________________________________ Date of training:_____________________________  Check $__________ (Make payable to "Sanford")  Credit Card $_________ (We accept Visa, MasterCard, Discover) Card #_________________________________ Name on card:___________________________ Expiration date:________ Security code:__________ (3 digit code on back) Fax: (701) 234-2917 All participants will receive certificates of attendance. Cancellations must be received 48 hours in advance for refund. If you have questions, please call (701) 234-2030 or (800) 437-4010, ext. 2030 or visit sanfordhealth.org (keyword: reasonable suspicion) 900-99000-0079/WD 49 Rev. 8/14 -0360 Payment (required in advance) $70 per attendee: Training for Supervisors Oct. 16 & Oct. 28 Required for DOT Supervisors Sanford Health Occupational Medicine offers drug and alcohol awareness in the workplace training for DOT and private sector company supervisors DOT Programs The following programs are designed for DOT (regulated) supervisors as they meet DOT training requirements as outlined in 49 CFR Part 382.603. Non-DOT supervisors may also attend, as they will find much of this information useful as well. Fargo, N.D. These programs provide excellent information on substance abuse detection in the workplace that is valuable to supervisors in any organization. After completing training, participants will: • know the physical, behavioral, speech and performance indicators of substance abuse • be able to approach employees with concerns in a professional and rational manner • gain knowledge about the appropriate way to initiate reasonable suspicion testing • learn how to complete required documentation • feel more confident about their responsibility for reasonable suspicion testing • understand DOT drug and alcohol regulations as they apply to reasonable suspicion testing • review current processes for collection, testing and reporting services NDSCS Skills & Technology Training Center 1305 19th Ave N Speaker: Vicki Hanson, Program Supervisor Vicki manages Sanford Health Workplace Drug Analysis Services. For the past 24 years she has worked closely with medical review officers assisting companies with their drug and alcohol testing programs. Vicki is a regional certified professional collector trainer through the Drug & Alcohol Testing Industry Association (DATIA) and a certified designated employer representative (C-DER). She provides a variety of programs to employers, employees and organizations to raise awareness of the use of illegal drugs and mis-use of alcohol in the workplace, and encourages supporting drug-free workplaces To have Vicki speak at your company, call (701) 234-2244 or e-mail [email protected]