Use of Alcohol or Drugs Forms

If you would like more information, please contact Consultation & Accountability:

Carrie Hughes, Personnel Analyst; cphughes@admin.nv.gov or (775) 684-0111

Form Title	Revision Date
Policy Statement - Alcohol/Drug Free Workplace and Acknowledgment TS-58 (Word) Policy Statement - Alcohol/Drug Free Workplace and Acknowledgment TS-58 (PDF)	7/1998
Report Form for Suspected Alcohol/Drug Impairment TS-77 (Word) Report Form for Suspected Alcohol/Drug Impairment TS-77 (PDF)	12/2017
Alcohol/Drug Consent Form TS-76 (Word) Alcohol/Drug Consent Form TS-76 (PDF)	4/2016
Non-DOT Breath Alcohol Test Request NPD-79 (Word) Non-DOT Breath Alcohol Test Request NPD-79 (PDF)	10/2013
Authorization for Release of Confidential Information (Word) Authorization for Release of Confidential Information (PDF)	7/2019
Required Referral Memo (Word)	7/2019