SURVEY QUESTIONNAIRE

Information from the official completing this form

Gender: Male Female

Age: 20 – 30 31 – 40 41-50 51-60 61 – 65

Years in government service: 1–5 6 – 15 16 - 25 26 - 35 36 or more

1. Does your office have a written policy regarding drug use in the workplace?

Yes No

2. Identify at least two (2) reasons why your office adopted a Drug-Free Workplace Policy?
To maintain a wellness initiative
To protect the health and safety of all employees, clients and the public
To maintain product/service quality, office integrity and reputation
To safeguard employer assets from theft and destruction

3. Indicate the activities your office conduct to promote a Drug-Free Workplace. (Select all that
apply)

Capability building
Continuing education and awareness
Value formation, family enhancement programs, etc.
Random drug tests
Employee assistance
Advocacy programs
Submission of reports

4. Does your office conduct regular/random drug testing for its job applicants/employees?
Yes No

5. Which of these are impacts of abuse in the workplace? (Select all that apply)

Employee health
Workplace security
Employee decision-making
None of the above

6. Does your office verify initial positive results through confirmatory tests?

Yes No

7. How does your office usually respond when an employee/applicant is confirmed positive for
drug use?

Undergo a Drug Dependency Examination

Undergo rehabilitation / counselling
Immediate Termination
Others, please specify

8. In your opinion, drug abuse/addiction ____________

does not affect the workplace
is treatable and reversable
is permanent
Is contagious