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National RFW Certification

Certification Application

Tell us how your workplace supports employees in recovery. The application is assessed against the Four Pillars, and you can save your progress and return to it at any time.

Before you begin

The application has seven steps and takes about 30 minutes. Each answer you claim points for asks for supporting documentation, so it helps to gather those files first. Your progress is saved as you go. Use Save and Continue Later to get a link back to your part-finished application.

Step 1 of 7

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Certification Application Form This application is for any employers that have employees based in the U.S. and wish to obtain national Recovery Friendly Workplace (RFW) certification. To apply for national RFW certification, please fill out this form, and upload any supporting documentation requested in the questionnaire. An employer’s application will be deemed complete when the Institute has received the employer’s application, supporting documentation, and application fee. Institute staff will examine applications and supporting documents to ensure that applicants are eligible for review and certification. The Institute will rate eligible applicants on a scale from 0 to 120 with points awarded for satisfying each criterion. Applicants that earn points under each of the four categories and score 40 points or higher will be certified. If an applicant does not qualify for national certification, the Institute will recommend actions the applicant may consider taking to qualify for certification. The Institute will certify qualifying employers for a period of two years. Nationally certified employers may seek recertification at the end of their certification term through an abbreviated recertification process.

Name of Employer(Required)

City and State of U.S. headquarters

Number of employees in U.S.(Required)

Provide an exact count or an estimate

Industry of employer(Required)

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Country Where Organized(Required)

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Employees in which U.S. states(Required)

Please enter state abbreviations seperated by a comma - NY,FL,CA

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Category of ownership(Required)

Privately owned, public company, employee-owned, nonprofit, etc.

Contact Person

Name of contact person(Required)

First Last

Title(Required)

Email(Required)

Phone(Required)

Include your country code if you are outside the U.S.

Alternate employer email

In case of personnel change

Culture (25 points available) Check all that apply.

RFW Policy: The employer has instituted and distributed a written RFW statement or policy affirming that:(5)

SUDs are treatable health conditions, comparable to other chronic health conditions;
SUD recovery is common;
Federal law requires health insurance coverage of substance use and mental health disorders to be in parity with coverage of physical health conditions, and the employer asserts its best efforts to comply with this requirement;
To the extent permitted by law, the employer strives to create a workplace where it is safe to ask for help and where SUD recovery is supported; and
Applicable industry- or sector-specific factors affecting how the employer addresses employee substance use are discussed in the employer’s drug-free workplace policy.

Indicate YES or NO

YES

RFW Policy

If the employer satisfies the RFW Policy criterion, please submit a copy of the RFW statement or policy. Sample policy available upon request.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Do you have a resource group:

The employer provides space for recovery-focused meetings and recognizes a recovery-focused employee resource group that includes the participation of an employee or consultant who holds a peer recovery support specialist, professional recovery coach, or similar Institute-recognized SUD-related certification.(5)

Indicate YES or NO

YES

Name of resource group

Participant’s SUD-related certification

Points

Do you offer the following:

Substance-Free Options: If alcohol is present during work functions, the employer provides non-alcoholic beverages (e.g., mocktails) and publicizes that those options are available.(5)

Indicate YES or NO

YES

File

If the employer satisfies the Substance-Free Options criterion, please submit a copy of a policy or announcement, or a photo of signage at a work function. Sample policy available upon request.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Do you have a senior executive who is a visible ally for the recovery community?

Highly Placed Ally: The employer has a senior executive (within two levels of the CEO) who is a visible ally for the recovery community.(5)

Indicate YES or NO

YES

Name of senior executive:

Title:

Link to bio or LinkedIn page:

Please provide a valid web URL

Points

Have you provided financial support to a charitable organization or event supporting people in recovery from, or otherwise affected by, SUDs in the last 12 months?

Charitable Support: The employer has, during the prior 12 months, provided significant financial or in-kind support to an external charitable organization or event supporting people in recovery from, or otherwise affected by, SUDs.(5)

Indicate YES or NO

YES

Name of organization or event:

Month and year of contribution

Points

Do you have any other examples of actions contributing to a Recovery Friendly culture you would like to be considered?

Other: If the employer has taken other actions to promote a recovery friendly culture and work environment that you would like to submit for consideration, please describe the actions below. You may also submit supporting documentation.

Indicate YES or NO

YES

Other actions to promote a recovery friendly culture

If the employer has taken other actions to promote a recovery friendly culture and work environment that you would like to submit for consideration, please describe the actions below. You may also submit supporting documentation.

Hiring, Retention, and Advancement (30 points available) Check all that apply

Do you have fair chance hiring practices or policies?

Fair Chance Hiring: In accordance with the laws that govern its workplaces, the employer permits individuals with SUD-related criminal records or debt to compete for job opportunities. The employer does not use background checks to bar applicants from the interview and offer stage(s), and there is a process in place to consider a candidate who may have SUD-related criminal records or debt.(10)

Indicate YES or NO

YES

File

Fair Chance Hiring - If the employer satisfies the Fair Chance Hiring criterion, please submit a copy of the fair chance hiring policy. Sample policy available upon request.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Do you have a contingent or return-to-work agreement or policy?

Contingent or Return-to-Work Agreement: Unless industry- or sector-specific factors apply and are addressed in the employer’s drug-free workplace policy, a candidate or employee with problematic substance use is offered screening, assessment, and conditional or continued employment under a contingent employment or return-to-work agreement.(10)

Indicate YES or NO

YES

File

Contingent or Return-to-Work Agreement - If the employer satisfies the Contingent or Return-to-Work Agreement criterion, please submit a copy of the employer’s contingent or return-to-work policy or agreement. Sample policy available upon request.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Do you participate in the following:

Proactive Recruiting: The employer seeks to recruit candidates in recovery from, or otherwise affected by, SUDs by, for example, collaborating with third parties, stating in job announcements that the workplace considers applicants in recovery, and stating on the employer’s website and LinkedIn profile that its workplace is recovery friendly.(5)

Indicate YES or NO

YES

Proactive Recruiting Text

If the employer satisfies the Proactive Recruiting criterion, please describe the recovery friendly recruiting method:

Points

Do you have flexible work options?

Flexible Work: The employer provides reasonable accommodations, such as flexible work options, to support employees’ (and their families’) health and wellness.(5)

Indicate YES or NO

YES

File

Flexible Work: - If the employer satisfies the Flexible Work criterion, please submit a copy of the employer’s flexible work policy. Sample policy available upon request.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Other Examples: Do you have any other examples of actions contributing to a Recovery Friendly hiring, retention, and advancement practices that you would like to be considered?

Indicate YES or NO

YES

Other Actions Hiring Text

If the employer has taken other actions to support the hiring, retention, and advancement of persons in recovery that you would like to submit for consideration, please describe the actions below. You may also submit supporting documentation.

Other Actions Hiring Retention(Required)

Other Actions: - Please submit supporting documentation.

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points Running Total

Benefits (40 points available) Check all that apply.

Credible Medical Guidelines: Employee benefits include health insurance coverage of:

SUDs, including the use of The ASAM Criteria to inform placement and continuity of care decisions and coverage appeals; and
Mental health disorders, including the use of the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) to inform placement and continuity of care decisions and coverage appeals.(10)

Indicate YES or NO

YES

File

If the employer satisfies the Credible Medical Guidelines criterion, please submit a copy of the relevant portion of the health plan contract or benefit description.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Do you have Reliable Health Insurance as defined below?

Reliable Health Insurance: Under the employer’s health plan:

Covered SUD and mental health treatment is available as directed by the participant’s health care provider without administrative hassles or delays, such as prior authorization and step therapy;
SUD and mental health provider network adequacy is consistent with the federal and state network adequacy standards applicable to small business marketplace plans;
Licensed providers who render covered services to plan participants receive timely payments based on market rates; and

Within two business days of receiving notice of plan participants’ concerns regarding access to covered health care products and services, network adequacy, or payments to providers, the employer troubleshoots such concerns.(10)

Indicate YES or NO

YES

Reliable Health Insurance

If the employer satisfies the Reliable Health Insurance criterion, please submit a copy of the relevant employer policy or describe the process for troubleshooting participants’ concerns.

Reliable Health Insurance Policy

You may submit a copy of the relevant employer policy here.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Have you obtained an independent review of your health plan contract and benefit description in the past 12 months?

Independent Review: Within the past 12 months, the employer has obtained an independent review of its health plan contract and benefit description by an appropriately qualified entity, such as a health care attorney or former health insurance executive (but not an active health insurance broker). The purpose of the review is to identify and eliminate features that impede or delay participants’ access to health care products and services ordered by their providers. Examples of such features include obligatory use of financial aid programs, mandatory foreign-drug importation, and cost containment fees calculated as a percent of the net savings of provider claim repricing.(10)

Indicate YES or NO

YES

Date of review

If the employer satisfies the Independent Review criterion, please submit the date of the review and name of the reviewer.

MM slash DD slash YYYY

Name of reviewer

Points

Do you provide No-Cost Assistance as described below?

No-Cost Assistance: Employee benefits include access to an SUD recovery-informed service provider, such as an employee assistance program (EAP) or member assistance program (MAP), that provides no-cost aid to employees in recovery from, or otherwise affected by, SUDs.(5)

Indicate YES or NO

YES

File

If the employer satisfies the No-Cost Assistance criterion, please submit a copy of the relevant portion of the service provider contract or benefit description.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points

Do you maintain a resource list as described below?

Resource List: The employer maintains and publishes or posts a list of health services in communities surrounding the employer’s workplaces or via telehealth. Examples include crisis, treatment, or recovery support services available through local recovery community organizations, Federally Qualified Health Centers, Certified Community Behavioral Health Clinics, mutual aid groups, public health departments, or the 988 helpline.(5)

Indicate YES or NO

YES

Resource List

If the employer satisfies the Resource List criterion, please submit a copy of the list.

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

How the resource list is shared

Please describe how the resource list is shared with employees.

Points

Do you have any other Recovery Friendly benefits that you would like to be considered?

Other: If the employer provides other recovery friendly benefits that you would like to submit for consideration, please describe the benefits below. You may also submit supporting documentation.

Indicate YES or NO

YES

Please describe the other recovery friendly benefits you provide

File

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points Running Total

Education and Awareness (25 points available) Check all that apply.

Do you affirm that the following has been implemented:

Employee Awareness: The employer or recovery program leader communicates with employees during orientation and at least twice annually thereafter about the employer’s RFW statement or policy, resource list, and, if applicable:

The availability of the SUD recovery-informed service provider, such as an EAP or MAP, to provide no-cost aid to employees in recovery from, or otherwise affected by, SUDs;
Workplace recovery support services, recovery-focused employee resource groups, or other resources for employees in recovery from, or otherwise affected by, SUDs; and
Employee health insurance coverage of substance use and mental health disorder benefits in parity with physical health benefits.(10)

Indicate YES or NO

YES

If the employer satisfies the Employee Awareness criterion, please describe the contents, method, and frequency of communication:

Points

Do you have at least one organizational leader, supervisor, or human resources staff member educated on the following:

SUD and Recovery Education: At least one organizational leader, supervisor, or human resources staff member has participated in education on:

SUDs as treatable health conditions from which personal recovery is common;
Overcoming SUD stigma and communicating with compassion and appropriate language; and
The rights of employees and obligations of employers under the Americans with Disabilities Act.(5)

Indicate YES or NO

YES

Title of educational program:

Name of education provider:

Number of personnel who participated in past 12 months:

Please enter a number from 1 to 1000.

Points

Is that education recommended for all supervisors and available to all employees?

Additionally, the aforementioned education is recommended for all supervisors and available to all employees.(5)

Indicate YES or NO

YES

Points

Have at least two employees at each workplace been trained on overdose prevention and reversal, with training available to workplace-security personnel and naloxone readily accessible?

Naloxone Access: Two or more employees in each of the employer’s workplaces have been trained on overdose prevention and reversal, such training is available to workplace-security personnel, and naloxone is readily accessible at all workplaces.(5)

Indicate YES or NO

YES

Number of U.S. workplaces:

Please enter a number from 1 to 1000.

Number of employees trained in past 12 months:

Please enter a number from 1 to 1000.

Places where naloxone is located:

Points

Do you have any other Recovery Friendly education and awareness activities that you would like to be considered?

Other: If the employer conducts other recovery friendly education and awareness activities that you would like to submit for consideration, please describe the activities below. You may also submit supporting documentation.

Indicate YES or NO

YES

Other Activities

File

Drop files here or

Accepted file types: doc, jpg, pdf, png, jpeg, Max. file size: 64 MB.

Points Running Total

By signing, I declare that I am an authorized agent of the employer named above, and I have undertaken reasonable efforts to verify the accuracy and completeness of the information provided in this Recovery Friendly Workplace National Certification Application, including the supporting documentation.

Signature

Name

First Last

Title

Date

MM slash DD slash YYYY