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Use of Alcohol or Drugs Forms

Use of Alcohol or Drugs Forms

If you would like more information, please email Consultation, Accountability, and Regulations at consultationar@admin.nv.gov.

    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

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