Legal Marijuana Use Attestation

LEGAL MARIJUANA USE ATTESTATION

This Legal Marijuana Use Attestation ("Attestation") is made and entered into on this date: by and between Organization Name: , with principal place of business at ("Organization"), and Attestor Name: , residing at ("Attestor").

RECITALS

WHEREAS, Organization maintains workplace safety, attendance, and performance standards that apply to all personnel, including rules regarding impairment while on duty or present on Organization premises; and

WHEREAS, certain jurisdictions permit the legal possession or use of marijuana for medicinal or adult-use purposes under applicable law, and Attestor wishes to attest to the lawfulness and circumstances of any such use; and

WHEREAS, Organization requires an express written attestation regarding off-duty marijuana use to document compliance with Organization policies and to establish conditions applicable to safety-sensitive duties.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Attestation, the following definitions apply: "Marijuana" means cannabis and cannabis derivatives or products containing tetrahydrocannabinol (THC); "Premises" means any real property, vehicle, equipment, or facility owned, leased, or controlled by Organization; "Safety-Sensitive Duties" means duties identified by Organization that, if performed while impaired, create an unreasonable risk of harm to persons or property.

2. ATTESTATION AND CERTIFICATION

Attestor hereby certifies, represents, and warrants to Organization that the following statements are true and complete as of the date below:

(a) Jurisdiction of Use: Attestor's lawful marijuana use, if any, is authorized under the laws of the jurisdiction where the use occurs: State or jurisdiction of lawful use:

(b) Nature of Use: Attestor's use is: Recreational Medicinal If medicinal, Attestor shall provide documentation to Organization upon request:

(c) Timing and Location Restrictions: Attestor affirms that any possession or use of marijuana occurs only off-duty and off Organization Premises and not while performing Safety-Sensitive Duties, except as expressly authorized in writing by Organization. Attestor further certifies that, to the best of Attestor's knowledge, Attestor is not under the influence of marijuana while on duty, on Organization Premises, or while performing Safety-Sensitive Duties.

3. ACKNOWLEDGMENTS

Attestor acknowledges that: (i) compliance with state or local laws permitting marijuana use does not excuse conduct that violates Organization policies; (ii) Organization may prohibit marijuana possession or use on Organization Premises notwithstanding lawful off-duty conduct; and (iii) impairment on duty is prohibited and may subject Attestor to disciplinary action up to and including termination.

4. TESTING, INVESTIGATION, AND REPORTING

Organization reserves the right to require testing or investigation where there is reasonable suspicion of impairment, accident, or violation of Organization policy. Attestor consents to such testing and to the release of test results to Organization for purposes of evaluating compliance with workplace rules. Attestor may request procedures for confirmatory testing in writing.

5. CONFIDENTIALITY AND LIMITED DISCLOSURE

Organization will treat medical information and test results as confidential and will disclose them only to persons who have a legitimate need to know for purposes of safety, compliance, accommodation, or as required by law. Organization's obligations of confidentiality are subject to applicable legal exceptions.

6. ACCOMMODATION; LIMITS

If Attestor asserts a need for a reasonable accommodation based on medical marijuana use, Attestor must submit a written accommodation request and supporting documentation. Organization retains the right to deny accommodation where the requested accommodation would create an undue hardship or where safety-sensitive duties are involved and a reasonable accommodation cannot eliminate the risk.

7. INDEMNIFICATION

To the fullest extent permitted by law, Attestor shall indemnify, defend and hold Organization harmless from any claims, liabilities, losses, costs or damages (including reasonable attorneys' fees) arising from Attestor's breach of this Attestation or from Attestor's impairment while performing duties or while on Organization Premises.

8. NOTICES

All notices required or permitted under this Attestation shall be in writing and delivered to the addresses below by hand delivery, certified mail, or other means providing receipt:

9. MISCELLANEOUS PROVISIONS

Governing Law: This Attestation shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles.

Entire Agreement: This Attestation constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, and representations, whether oral or written.

Severability: If any provision of this Attestation is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect and the invalid or unenforceable provision shall be reformed to the extent necessary to make it enforceable while preserving the parties' intent.

Amendments; Waiver: Any amendment or waiver of any provision of this Attestation must be in writing and signed by both parties. The failure of either party to enforce any provision shall not constitute a waiver of future enforcement of that or any other provision.

Counterparts: This Attestation may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

ADDITIONAL INFORMATION

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