|
Application for Drug-Free Workplace Program and Drug-Free EZ
(U-140)
|
|
Introduction
The Drug-Free Workplace Program (DFWP) is a BWC rate program
which offers a premium discount to eligible employers for implementing a program
addressing workplace use and misuse of alcohol and other drugs, including
prescription, over-the-counter, and illegal drug abuse.
BWC understands that small businesses typically have fewer resources available to
implement our DFWP. That's why BWC has developed Drug-Free EZ (DF-EZ). BWC defines
a small business as a company with an average of 25 or fewer full-time employees.
|
|
Additional information
DFWP info
DF-EZ program info
State construction contractor information
Drug-Free Vendor Directory
|
|
Required information
- Name of Employer
- Doing Business As (DBA) Name
- Address
- Telephone Number
- Federal Tax ID Number
- Employer Contact Person
- Employer Contact Telephone Number
- Total Average Work force (Number of employees considered full-time equivalents)
|
- Existing Substance-Free Program (one or more years)
- Beginning Date for Existing Substance-Free Program
- Program Period Dates
- DFWP or DF-EZ Level Requested
- Name of Designated Employer Representative if submitted online
|
|
|
| Complete the forms |
|
The free Adobe Reader
software is required to display and print the application.
Do you have all the required information at hand? If so, you are ready to begin
completing the form. When completing the online form, please use the previous
and next buttons located at the bottom of the page to navigate
through the form.
Begin online form now.
Are you missing some of the required information? If so, you may return here
at a later time when you have all the information you need, and complete
this online form. Or, you may print a blank copy of the form to complete by
hand and either mail or fax it to BWC.
Print a blank form.
|
|
