N.C. Department of Health and Human Services
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Alcohol and Drug Free Policy Acknowledgement

Why do I need to fill out this form?

DHHS is committed to maintaining an alcohol and drug free workplace for the safety and well-being of our employees and those we serve. You are required to sign this form to acknowledge that you understand your responsibilities and the department's guidelines for handling job performance issues related to alcohol, drug use and circumstances when drug or alcohol testing is required or allowed.

Click here to read the policy before you sign the form. If you have any questions ask your supervisor or HR Representative.

* .PDF refers to Portable Document Format, which is a readable format for many types of web documents. If you do not have Adobe Acrobat Reader installed on your computer, you will not be able to see the form. Acrobat Reader is free and available at the Adobe website:

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Click here to return to the Forms List page.

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