HomeMy WebLinkAbout20230797.tiffI NDUSTRIAL
H EALTH
S ERVICES
N ETWORK
P.O. Box 490, HUDSON, WISCONSIN 54016
February 14, 2023
Ms. Michelle Raimer
Weld County Coroner's Office
P.O. Box 758
Greeley, CO 80632
Dear Michelle:
Following is the service proposal/agreement to establish a new account for the Weld County
Coroner's Office. To establish this new account, please complete and return the service agreement
and enrollment forms (found at the end of the proposal document). We will invoice you for the set-up
fees. If you have any questions about the services and pricing presented in this proposal, please call
me at 800-880-4444, ext. 101.
Sincerely,
Emily S. Battis
President
2023-0797
an rii_ Phone 15) 386-1990 ♦ Fax: (713..8"?-7,•mail:15n@ihsn.com Emai : ihsn@ihsn.com • Web Site: www.ihsn.com 0003
03/ Z.0123 " L3Atofr3 Pe0035
Premier Service Program
IHSN's Premier Service Program is a high service model designed for employers who want a
comprehensive solution for their drug and alcohol testing program needs. This service package
is ideal for employers who want the assistance and experience of knowledgeable staff to
coordinate their testing services and assist with the administration of their program. Clients who
enroll in our Premier Service program receive the following Superior Quality and Value Added
Service Package:
IHSN Services Guide
Upon enrollment each IHSN client receives our valuable IHSN Services Guide. Our IHSN
Services Guide provides:
• An introduction to our service program,
• Answers to your common service questions,
• A listing of your designated service providers (Lab, MRO & collection sites),
• Program Management Resources,
• Sample Forms,
• Sample Company Policy Information, and
• Tabbed sections for you to store your service contracts and copies of our monthly
newsletter, IHSN ews.
This handy ring -bound guidebook is divided into convenient tabbed sections for easy reference
and convenient storage of your important program documents.
Laboratory and MRO Services
IHSN makes using or changing to our services a snap by making all the arrangements for
establishing your laboratory testing and Medical Review Officer (MRO) accounts. IHSN will set-
up your account with one of our contracted top quality SAMHSA certified labs and establish your
MRO services account with our MRO Services Department. IHSN also takes care of ordering
and arranging for the laboratory to ship the initial supply of drug testing materials directly to you or
to each of your designated collection sites, making a change to IHSN services a breeze!
Test Panel
Employers who enroll in our Premier service program receive their choice of testing panels.
Employers can select our standard 5 -panel, 7 -panel, 10 -panel or a custom panel drug screen.
Our standard 5 -panel drug screen tests for THC/Marijuana, Cocaine,
Amphetamines/Methamphetamines, Opiates and PCP. Our standard 7 -panel drug screen tests
for all substances included on the 5 -panel test plus benzodiazepines and barbiturates. Our
standard 10 -panel drug screen tests for all substances included on the 7 -panel test plus
methadone, methaqualone and propoxyphene.
Rapid Result Reporting
IHSN understands that drug test results cannot come too soon. Your company's critical
personnel and operations decisions depend on them. Our MRO Services Department is
dedicated to providing the rapid, top quality service you need. Negative test results are generally
reported the afternoon following specimen collection (provided the collection facility ships the
sample the same day it is collected and faxes a copy of the MRO copy of the custody and control
form to our offices the day of collection). Positive laboratory test results are handled immediately
upon receipt from the laboratory ensuring minimal wait times for your MRO verified result.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Premier Service Program
Specimen Collection Supplies
IHSN provides all specimen collection supplies needed for drug testing including:
• Specimen collection and bottle containers
• Custody and Control Forms (CCF) pre-printed with your company's account information;
and,
• Courier overnight shipping envelope and airbill for sending specimens to your designated
SPNIHSA-certified lab
IHSN will order and ship the initial supply of testing materials to you or directly to your collection
site(s).
Collection Site Location and Account Set -Up
Our Premier service clients receive IHSN's Collection Site Locator & Account Set-up Service.
Locating and establishing urine specimen collection and alcohol testing sites is critical to the
success of your Drug and Alcohol Testing Program. Using our vast collection site database and
collection site locator resources, we will locate collection sites in your designated testing areas
and help you determine which sites best meet your unique service needs. We will then
coordinate the set-up of your account at each chosen collection site by providing the site with
detailed instructions concerning the establishment of your account, including:
• Your company name, address, phone numbers and authorized contacts
• The names, addressees and phone numbers of your testing lab and MRO
• Specimen shipping instructions
• Instructions concerning how to order additional testing supplies,
• Instructions concerning the disbursement of testing paperwork, and
• Billing instructions
Additionally we will also order and ship the initial supply of specimen collection materials to each
collection site or if you prefer we will ship the supplies directly to you for distribution to your sites
or employees. IHSN will also act as a liaison between the employer and the collection site on an
ongoing basis.
Premier Random Selection Services
IHSN's drug and alcohol random selection services are included at no extra charge for clients
enrolled in our Premier service program. IHSN's sophisticated computerized random selection
service E designed to simplify the management and employee list maintenance duties of your
random selection program. IHSN creates an individual random selection pool for each client
enrolled in our Premier service program. To help you keep your employee list up to date, each
quarter IHSN sends you a reminder to submit changes to your employee list. Our easy to
complete update forms or electronic submission procedures make updating your employee list
quick and painless!
Our random computer system automatically calculates the number of random selections required
for the quarter and then selects the appropriate number of employees for random drug and/or
alcohol tesing. We also automatically select a percentage of alternates in addition to the primary
selections. These alternates are provided for your convenience to be used in cases when the
original employees selected are not available for testing due to termination, medical leave, etc.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Premier Service Program
Premier service clients also receive the following additional random selection service and
reporting benefits.
For Premier service clients, our computer system tracks your drug tests as they enter our test
results system and matches the selections made to the random tests you have completed. If
a test enters our test results system labeled as a random test, but does not match a selection
in our system, (i.e. the test was marked as a random, but is actually a different category of
test; or the SS# on the paperwork does not match the SS# in our data base; etc.) we
automatically contact you to determine the cause of the discrepancy and then submit any
necessary data changes to the testing laboratory. This process ensures that all of your
random testing is properly completed and labeled so that your IHSN random progress and
laboratory statistical reports will reflect the correct data.
Premier service clients are sent a progress report just prior to the end of each selection
period detailing the status of the random drug testing for the current period. This report
includes a summary of the number of selections made, the number of drug tests completed to
date and the number of drug tests remaining to be completed for the selection period. This
value added report is a timely management tool providing either a confirmation that you have
completed all the required drug testing for the period or a friendly reminder that you still have
testing to complete before the period ends.
• Premier Service Clients who fail to complete their random testing by the end of the selection
period are issued a notice of non -completion each month until the testing has been
completed. These friendly reminders are designed to assist you in maintaining compliance
with your company policy or vendor contracts and serve as a gentle reminder that you still
have outstanding tests that need to be completed.
Our Premier random selection system makes managing your random selection program as easy
as 1-2-3!
Please Note: If a client does not complete all the required random selections for two successive selection
periods, IHSN reserves the right to cancel random selection services on the account.
Access to IHSN's Non -Emergency Over -The -Road Collection Site Set-up Services
Because it is not always possible or convenient to use your permanent collection sites for pre-
employment, random or other testing, IHSN offers our Premier service Clients our IHSN "Over -
the -Road" Collection Site Set -Up Service. To use this service simply call our toll free number
during regular office hours. We will locate a collection site in the requested area and make all the
arrangements for the required testing. We then call you back with the facility information so you
can direct your employee to the test site. This service is a great tool for completing random
testing on -the -road or pre -employment testing on applicants who live far distances from your
place of business, saving you travel and lodging expenses when qualifying applicants.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Premier Service Program
Premier Specimen Status Tracking & Expedited Result Reporting
IHSN understands that drug test results cannot come too soon, your critical personnel decisions
depend on them. If you are particularly anxious about the status of a pending test result simply
call our offices. Our MRO staff will contact the lab to 1) verify that the lab has received the
specimen, 2) determine the testing status of the specimen and, 3) obtain an estimate of when the
lab is expected to release the result to the MRO for review.
In addition to contacting the lab to verify the status of your test results, for Premier service clients,
our MRO staff will also contact your collection site to verify that the employee did complete the
test, we will verify when the sample was shipped, and track the specimen with the courier service
responsible for transporting the specimen to the testing laboratory. If you are particularly anxious
about a specific result, for Premier service clients, our MRO staff can also enter a "flag" in our
computer system that will automatically notify the staff member the minute that specific result is
received into our computer system. The result can then be flagged for "priority or emergency"
processing to further expedite the MRO review and reporting process.
Expedited Correction of Custody and Control Form errors
Some MRO's simply cancel specimens that are submitted to the lab with minor Custody and
Control Form Errors (i.e. missing date, missing collector signature, collector failed to mark test
type, etc.) rather than taking the time to correct them. Other MRO's leave it up to the laboratory
to obtain the necessary documentation required to correct paperwork errors. These practices
cost the employer not only time and lost revenue, but also the cost and hassle of arranging for a
second collection if the sample must be re -collected. IHSN, however, takes an active role in the
correction process. When a correctable Custody and Control form error occurs, the laboratory
notifies our MRO of any errors for your account. Our MRO administrative staff then expedites the
correction process by coordinating with the collector to correct the error. Our MRO staff contacts
the collector to inform the collector of the error, review the proper procedures to ensure that the
error does not happen again, and obtain the necessary corrective paperwork. This involvement
in the correction process to expedite the correction of custody and control form errors is not
common practice for most MRO organizations. Our MRO Services Department is committed to
going the extra mile, ensuring that you receive your test results as rapidly as possible. This
commitment to excellence speeds up the processing time for Custody and Control form errors
saving you time and money.
Regular Customer Service Account Reviews
All Premier service clients receive regular account reviews. Our friendly, dedicated staff will
contact you to review your account history and point out any changes in testing activity that may
indicate a service or compliance concern. This personalized service helps you identify and
correct compliance issues before they become a problem.
Subscription to IHSNews
Our monthly newsletter, IHSNews provides articles on a variety of drug and alcohol testing topics.
One subscription to IHSNews is provided to each IHSN client as part of their service program.
IHSN's on-line Resource Center
Premier service Clients have access to our on-line Resource Center. This Resource Center
located on IHSN's web site (www.ihsn.com) provides access to:
• Program Management Tools
• Past issues of IHSNews, and
• Links to Variety of useful DOT, Government and Industry Drug and Alcohol Testing Web
Sites.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Premier Service Program
Drug and/or Alcohol Free Workplace Policies
IHSN recommends that any employer requiring employee drug and alcohol testing have a written
drug and/or alcohol testing policy for their company. Due to the fact that testing regulations vary
from state to state, it is not possible for IHSN to provide a model policy that would comply with the
laws of all 50 states. IHSN recommends that you engage the services of a competent attorney to
develop a testing policy specific to your state law and individual company needs. Listed below
are some sources for information concerning state drug testing laws that may assist you with the
development of your company policy.
Your company legal counsel: Your company legal counsel should be able to assist you in
identifying any state drug testing laws that you must comply with as well as assist you in writing
your company policy.
Your State Attorney General's Office: Your State Attorney General's Office should be able to
provide you with information regarding your state's drug testing laws.
U.S. Department of Labor: This web site features a variety of information and resources
concerning how to develop a drug free workplace policy, including a policy builder module.
http://www.doLcovielaws/druqfree.htm
Substance Abuse and Mental Health Services Administration: This site provides information
and tools regarding drug -free workplace programs. You can access this web site at
http://www.samhsa.qov/workplace
Drug Free Workplace — Office of National Drug Control Policy: This web site offers a variety
of information and resources regarding drug free workplace programs including links to state and
local drug offices and publications.
http://www.whitehousedruqpolicv.qov/prevenVworkplace/index.html
The National Clearinghouse for Alcohol and Drug Information: This web site features
publications for workplace drug testing programs. httpi/www.health.orq/workplace
DTState Laws: This is a multimedia subscription information service that offers subscribers access
to state statutes, court decisions, issues forums, state news, and employer notes concerning
workplace drug and alcohol testing. For more information visit http://www.dtstatelaws.com/
Institute for a Drug Free Workplace: This organization provides a variety of publications to
assist employers in implementing and maintaining their drug free work place programs including a
guide to state and federal drug testing laws. http://store.druafreeworkplace.oro/publications.aspx
Optional Services
Employee Information and Supervisor Training Programs
Employee Information and Supervisor Training Programs are key to maintaining an effective drug
and alcohol testing program. It is essential that employees understand not only what is expected
of them, but also what to expect when they submit to drug and alcohol testing. Our employee
guide is packed with easy to read information and includes a certificate of receipt for your
personnel files. This guide is available to download from the clients only area of our web site at
no extra charge.
Supervisors play a crucial role in an effective drug and alcohol -testing program. More than
anyone else, they are in a position to recognize changes in an employee's job performance. Our
supervisor -training guide gives your supervisors the tools they need to make reasonable
suspicion determinations. This training manual is available to download from the clients only area
of our web site at no extra charge and is packed with valuable information, including sample
forms and a certificate of completion.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Drug Screen Collection & Alcohol Testing Services
IHSN will work with your existing provider location(s) or will establish drug screen collection and
alcohol testing sites for you. Below you will find our suggestion(s) for service providers in the
areas you requested. If you prefer to work with a different facility than the site(s) listed below,
please provide your representative with the name, address and phone number of the site of your
choice. Fees for drug screen collection and alcohol testing services will be the usual and
customary =ees charged by the site. Unless otherwise noted below, all fees for services provided
by your collection site will be billed to you directly by the provider site. The collection site service
fees listed below are based on the collection site's current fee schedule and are subject to
change witiout notice. Please note that collection and alcohol testing fees are in addition to
IHSN's testng fees.
Banner Occupational Health - Greeley Hours: M -F: 8:00 am - 5:00 pm
1517 161, Ave Court Walk ins are accepted for
Greeley, CO 80631 collections & breath alcohol
testing.
Appts are required for
physicals.
Contact: Kathy Busse Urine Specimen $35.00
Collection Fee:
Phone: (970) 810-6810
Fax: (970) 810-6431
Breath Alcohol $40.00
Screen Fee:
Breath Alcohol $0.00 (no extra charge)
Confirmation Fee:
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
IHSN Program Materials
The following IHSN Program materials am all available to download at no extra charge from the
Clients Only area of our web site.
Supervisor's Reasonable Suspicion Training Guide
This manual is designed to provide your supervisors with information concerning the physical, behavioral,
speech and performance indicators of drug and alcohol abuse. Additionally, this manual offers guidance
concerning how to approach employees when reasonable suspicion testing is required and how to
document the request for testing (sample forms included).
Employee Drug & Alcohol Testing Information Guide
This booklet is designed to educate your employees about the dangers and health effects of the use and
abuse of drugs and alcohol as well as information regarding what to expect when they submit to drug
and alcohol testing.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Service Fees
IHSN Premier Service Program
HON Services Guide
SAWIHSA Laboratory Testing
Choice of Test Panel (5 -Panel, 7 -Panel, or 10 -Panel)
Certified Medical Review Officer Services
Aubmated Results Reporting
Positive Test Results Confirmed by GC/MS
Specimen Collection Supplies
Colection Site Referral Services & Account Set -Up Services (First 2 sites free, fee for
each additional site)
Premier Random Selection Services
Access to IHSN's Over The Road Collection Site Set -Up Services
HSN's Premier Customer Service Package
Prenier Specimen Status Tracking
Expedited Correction of Correctable Custody and Control Form Errors
Regular Customer Service Account Reviews
Subscription to IHSNews
Employee & Supervisor Training Program Materials (available to download)
Password Access to IHSN's On -Line Resource Center
One Monthly Billing Statement for Lab, MRO and any other IHSN Services
Annual Service Fee: $249.00*WAIVED
One Time Account Set -Up Fee $75.00
Fee Per Drug Test: $45.50**
*Annual fee is waived as long as the client has an active DOT account with IHSN. An annual fee will be
implementedlfor this non -DOT testing account if the client should close its DOT account or request that either
random selection services or separate billing statements be provided for the non -DOT account.
Optional Services
Collection Site Referral & Set -Up Services First 2 sites free, $55 fee for each additional site
Urine Specimen Collection Combined Billing Service $5.00/test
One Time Use/Over The Road Site Set -Up Services $55.00 per set-up plus
testing and collection fees
Split Specimen Re -test $205.00 per test**
SAP Referral Services $175.00 per referral
Employee & Supervisor Training Programs Available to download at no additional charge
*Test Fees are based upon a maximum positive rate of 5 % per year. Positive test results above the 5 %
maximum annual rate will be subject to an additional $60.00 fee per test. If translation services are required
for an MRO interview with a non-English speaking employee, the MRO will utilize the translation services of
AT & T Language Line. The employer will be charged a per minute translation fee based upon the current
rate charged by AT & T Language Line.
** Split Specinen re -test fees are billed to the employer and the employer is responsible for payment of all
split specinen re -test fees. The employer may choose to seek reimbursement from the employee according
to the employer's company policy.
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Premier Service Enrollment Form
Our Testing Program Is: ® Non-DOT/Company Policy
0 Mandated by Government Regulations (If you selected this option, please stop
here and contact your IHSN representative to request the correct enrollment form)
Test panel choice: 0 5 panel (standard) ® 5 panel (DOT Look Alike) 07 panel 010 panel
Result Reporting Preferences
Results should be directed to the following address:
Mailing Address: 1150 O Street
city. State, zip: Greeley CO 80631
Phone: ( 970 ) 400-4234
Please list the names of the individuals authorized to receive test results (please list phone # if
different than number listed above):
Primary person Michelle Reimer
2nd person Jill Scott
3. Person
Desired reporting method:
Auto Fax reporting is a computerized faxing system that immediately faxes test results to your
secure fax upon release by the MRO. If auto fax is selected, you must have a secure fax with
access to this fax Limited to only those individuals authorized to receive test results.
Email reporting uses encrypted email to immediately email test results to you upon release by the
MRO.
Phone reporting: A representative will call you with your test results and a written copy will be
mailed to you.
Mail only reporting: When the result is released by the MRO for reporting, a written copy of the
result is mailed to you. This is the least efficient way to receive results and is not recommended
for clients who are anxiously awaiting test results.
Select one: ['Auto Fax ®Email** ❑Phone* ❑Mail only
If Auto fax reporting is selected, enter the secure fax number to report results to:
(
Email: HumanResources(rweldgov.com
**Email reports can be sent to one email address only. If more than one person needs access to
the results, the primary contact can forward them to the other contacts or if you have a group email
for distribution to multiple staff members, we can send results to a group email address.
* If phone reporting is selected, the client will receive a preliminary verbal result report
via phone. A final result report signed by the MRO is then sent via U.S. Mail.
Newsletter Subscription:
A copy of our newsletter publication, IHSNews, is provided to each client as part of their annual
program fee. The newsletter is sent out by email. Please list the email address that you would like
your newsletter sent to:
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
Premier Service Enrollment Form
Random Selections
Does you require random pool/random selection services for this account? EJYes ® No
Billing Information
Accounts Payable Contact: Michelle Raimer
Phone: ( 970) 400-4234
Billing Address: 1150 O Street
City, State, Zip: Greeley CO 80631
Fax:
Physical/Snipping Address
Street Address: 1150 O Street
City, State, Zip: Greeley CO 80631
Program Fees
Item Description
Quantity
Unit Price
Total
Annual Service Fee
1
$249.00
WAIVED
One time account set up fee
1
$75.00
$75.00
Subtotal
Shipping A Handling: Introductory Materials
1
$17.95
$17.95
Total
$92.95*
*IHSN will bill you for these fees.
To establish Your Account, please submit the following to:
Industrial Health Services Network, Inc.
Attn: Account Setup
P.O. Box 490, Hudson, WI 54016
Fax: (715) 386-9308
Email: customerservice@ihsn.com
1. Your signed Service Agreement
2. Your completed Enrollment Form
INDUSTRIAL HEALTH SERVICES NETWORK, INC.
Service Agreement
DURATION OF OFFER: This offer is open for 30 days from the date of this proposal
DURATION OF PRICING: Annual fee and test fees are effective for term of this agreement. IHSN reserves
the right to increase client's annual fee or test fees due to regulation changes or unforeseen increases in
laboratory, shipping or other costs. IHSN will provide Client a written notice of any mid term increase in the
annual fee or test fees 30 days in advance. Fees at renewal will be IHSN's present market price at the time of
renewal. Fees for all other services are subject to change without notice.
PAYMENT TERMS: Invoices are issued monthly, and payment is due within 15 days of the invoice date.
CUSTOMER SATISFACTION GUARANTEE: Subject to the conditions below, if customer is dissatisfied with
IHSN's quality of service or support, IHSN will, at customers written request: (i) cancel service and close the
account, and (ii) cancel customers contract without liability for the termination fee. CONDITIONS TO
SATISFACTION GUARANTEE:
1. IHSN must receive written notice of the issue from the customer.
2. The issue must be attributable to facilities or causes within IHSN's reasonable control; for example, problems
caused by acts of God, natural disasters, inclement weather or third parties are not grounds to invoke the
guarantee.
3. If the issue is due to the performance of a subcontracted or coordinated third party service provider (i.e. lab,
MRO, collection site, etc.) IHSN must be reasonably given the opportunity to (i) resolve the problem with the
existing service provider, or (ii) change service providers and pass through any corresponding differences in
service provider fees. If there is no alternate service provider reasonably available or customer is unwilling to
accept an alternate service provider, then the issue shall not be covered by this satisfaction guarantee.
4. IHSN is unable to resolve a covered problem to customers reasonable satisfaction within 30 days after
receipt of written notice.
5. Customer's account must be current (no balance older than 30 days).
TERM AND TERMINATION: Client agrees that IHSN will be its sole provider of the drug and alcohol testing
services covered by this agreement, unless those services are not available because of location, emergency or
necessitated by regulations or government authorities. This agreement shall be for an Initial Term of 1 year
from the date signed by the Customer. Upon expiration of the Initial Term, this agreement shall automatically
renew for successive 1 year periods at IHSN's present market price at the time of renewal. Customer or IHSN
may terminate this Agreement at the end of any term by submitting a written notice to the other party at least
thirty (30) days prior to the end of such term. If service is terminated prior to expiration of the current term,
whether by IHSN for customer breach, or by Customer other than under the Customer Satisfaction Guarantee,
Customer shall forfeit all annual fees paid and upon demand by IHSN pay a termination fee equal to either 1)
the average monthly billing for all prior months of the current term multiplied by the number of months remaining
on the current term or 2) the average monthly billing for the last 12 months multiplied by the number of months
remaining on the current term, whichever is greater.
AMENDMENTS: Changes in federal or state regulations or standard testing practices may necessitate periodic
amendments to the terms of this agreement. In the event an amendment is necessary, IHSN will issue a written
notice to the client. Continued use of IHSN services after written notification will constitute acceptance of the
amended terms by client.
ACCEPTANCE: Acceptance may be made by email, mail or fax. Email and fax documents shall serve as
originals.
ENTIRE AGREEMENT: This written Agreement and the accompanying Service Fees sheet constitute the
entire agreement between the parties and supersedes any prior or contemporaneous proposals, discussion, or
agreements, whether verbal or written.
CHOICE OF LAW: This agreement shall be construed and controlled by the laws of the State of Wisconsin and
both parties further consent to the jurisdiction of the state and federal courts sitting in that state.
Customerherebyaccepts and agrees to the terms,,�gpnditions and pricing as stated in this proposal.
per. Nifh9CO Cen rrl 411O For Industrial Health Services Network, Inc.
(Comps Name)
By t rni111 4�tjGyt`lYW I t t' tcil k'( t r IJ
(Name of Authorized Representative) Emily S. Bettis, President VND010123
u--•�.._ Date: ! 1-,)\los9).
(Signature of Authorized Representative)
INDUSTRIAL HEALTH SERVICES NETWORK, I N C .
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