BCABEAP Alcohol & Drugs Policy Violation Referral Form | Boilermaker Contractors' Association

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BCABEAP Alcohol & Drugs Policy Violation Referral Form

For assistance, please contact Sara Scott (905-684-2244) at the BCA. Please fill in the form below.

All fields with asterisks (*) are required.

Date of Incident:*
MM slash DD slash YYYY
First Name of Worker:*
Last Name of Worker:*
Worker Home Phone:
Worker Cell Phone:
Worker Home Address:
RSAP ID:
Legal Name of Organization:*
Please avoid abbreviations.
Name of Individual Making Referral:*
Position:*
Email 1:*
Email 2:
Email 3:
Phone Number:*

Name of Project:*
Name of Contractor Employing:*
Or, name of contractor who intended to employ individual referred, if different from referring organization.
Date of Dispatch:
MM slash DD slash YYYY
The Work in question is:*
- Construction
- Maintenance
- Fabrication
If "other", please explain.
BCABEAP Contributions:*
- Yes
- No
- Unsure
Is the contractor making contributions and sending data to the Boilermaker Contractors of Alberta Employee Assistance Program (BCABEAP)?
RSAP Contributions:*
- Yes
- No
- Unsure
Is the contractor making contributions to the Rapid Site Access Program (RSAP) for the work in question?

Testing Compliance:*
- Yes
- No
- NA
Was the testing performed in accordance with the Canadian Model Alcohol and Drug Work Rule? (i.e. breath alcohol with confirmation plus 5 panel urine-based laboratory analysis with MRO review of non-negative results)
This referral is in respect to:*
- Site access test
- Site access - Site transfer
- Site access - Name hire
- Post incident
- Reasonable cause
- Follow-up test
- Camp Infraction
- Travel Infraction
- Possess or offer for sale
- Random (Owner Requirement)
Reason for violation:*
- Positive alcohol & drug test
- Refusal to test
- Evidence of substitution or tampering
- Failure to provide adequate sample
- Not applicable - Self referral
- Not applicable - Camp or Travel Infraction
- Not applicable - Possess or offer for sale
Self disclosure?:*
- Yes
- No
Upload applicable documents:
Drop files here or

Max. file size: 256 MB.
Please attach copy of the Custody Control Form, Dispatch Slip & A&D Test Results if applicable & available.
Additional Comments:
Contractor / Union - please provide additional comments relevant to the case management of this file, as necessary.
Comments
This field is for validation purposes and should be left unchanged.

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Boilermaker Contractors’ Association
#102, 20 Corporate Park Dr.
St. Catharines, ON L2S 3W2
Tel: 905-684-2244
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