EPPA Notice to Examinee

Notice to Examinee                                                     U.S. Department of Labor
Employee Polygraph Protection Act
                                                                       Wage and Hour Division
The Employee Polygraph Protection Act (EPPA) prohibits most private employers from using lie detector
tests either for pre-employment screening or during the course of employment. EPPA section 8(b) and U.S.
Department of Labor regulations (29 C.F.R. § 801.22-.25) require the following information to be provided to
a prospective examinee orally and in writing before taking a polygraph examination that is permitted under
                                                                                                                OMB No.: 1235-0005
the exemptions provided in sections 7(d), (e), and (f) of the Act. These exemptions are applicable to certain
                                                                                                                Expires: 10/31/2026
ongoing investigations, to security services, and to the security of controlled substances. Failure to
provide this information will result in the employer’s or prospective employer’s inability to claim these
exemptions. This notice conforms to Appendix A of the EPPA regulations, 29 C.F.R. Part 801, 56 Fed. Reg.
9064, Mar. 4, 1991; 56 Fed. Reg. 14469, Apr. 10, 1991.

Section 8(b) of the Employee Polygraph Protection Act, and                      (2) Any statement made by you before or during the
Department of Labor regulations (29 C.F.R. §§ 801.22,                                 test may serve as additional supporting
801.23, 801.24, and 801.25) require that you be given the                             evidence for an adverse employment action, as
following information before taking a polygraph examination:                          described in 3(b) above, and any admission of
1. (a) The polygraph examination area [does] [does not]                               criminal conduct by you may be transmitted to
          contain a two-way mirror, a camera, or other device                         an appropriate government law enforcement
          through which you may be observed.                                          agency.
     (b) Another device, such as those used in conversation           4.   (a) Information acquired from a polygraph test may be
          or recording, [will] [will not] be used during the                    disclosed by the examiner or by the employer only:
          examination.                                                          (1) To you or any other person specifically
     (c) Both you and the employer have the right, with the                           designated in writing by you to receive such
          other's knowledge, to record electronically the entire                      information;
          examination.                                                          (2) To the employer that requested the test;
2. (a) You have the right to terminate the test at any time.                    (3) To a court, governmental agency, arbitrator, or
     (b) You have the right, and will be given the opportunity,                       mediator that obtains a court order;
          to review all questions to be asked during the test.                  (4) To a U.S. Department of Labor official when
     (c) You may not be asked questions in a manner which                             specifically designated in writing by you to
          degrades, or needlessly intrudes.                                           receive such information.
     (d) You may not be asked any questions concerning:                    (b) Information acquired from a polygraph test may be
          Religious beliefs or opinions; beliefs regarding racial               disclosed by the employer to an appropriate
          matters; political beliefs or affiliations; matters                   governmental agency without a court order where,
          relating to sexual preference or behavior; beliefs,                   and only insofar as, the information disclosed is an
          affiliations, opinions, or lawful activities regarding                admission of criminal conduct.
          unions or labor organizations.                              5.   If any of your rights or protections under the law are
     (e) The test may not be conducted if there is sufficient              violated, you have the right to file a complaint with the
          written evidence by a physician that you are                     Wage and Hour Division of the U.S. Department of Labor,
          suffering from a medical or psychological condition              or to take action in court against the employer.
          or undergoing treatment that might cause abnormal                Employers who violate this law are liable to the affected
          responses during the examination.                                examinee, who may recover such legal or equitable relief
     (f) You have the right to consult with legal counsel or               as may be appropriate, including, but not limited to,
          other representative before each phase of the test,              employment, reinstatement, and promotion, payment of
          although the legal counsel or other representative               lost wages and benefits, and reasonable costs, including
          may be excluded from the room where the test is                  attorney's fees. The Secretary of Labor may also bring
          administered during the actual testing phase.                    action to restrain violations of the Act, or may assess civil
3. (a) The test is not and cannot be required as a condition               money penalties against the employer.
          of employment.                                              6.   Your rights under the Act may not be waived, either
     (b) The employer may not discharge, dismiss, discipline,              voluntarily or involuntarily, by contract or otherwise,
          deny employment or promotion, or otherwise                       except as part of a written settlement to a pending action
          discriminate against you based on the analysis of a              or complaint under the Act, and agreed to and signed by
          polygraph test, or based on your refusal to take such            the parties.
          a test without additional evidence which would
          support such action.                                        I acknowledge that I have received a copy of the above notice,
     (c) (1) In connection with an ongoing investigation, the         and that it has been read to me.
                 additional evidence required for an employer to
                 take adverse action against you, including                  __________________________________
                 termination, may be (A) evidence that you had               (Date)
                 access to the property that is the subject of the
                 investigation, together with (B) the evidence
                 supporting the employer's reasonable suspicion              ___________________________________
                 that you were involved in the incident or activity          (Signature)
                 under investigation.

                                                                                                                     Form WH-1481
                                                                                                                     Revised: April 2011
                                            Public Burden Statement

Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number. The information provided under this information collection is required in order to obtain a benefit
for limited exemption provided in sections 7(d), (e), and (f) of the Act. The Department of Labor uses this
information to determine whether an employer has met the exemption requirements. Failure to provide this
information will result in the employer’s or prospective employer’s inability to claim these exemptions.

Public reporting burden for this information collection is estimated to average 1 minute. Comments regarding this
burden estimate or any other aspect of this information collection, including suggestions for reducing this burden,
may be sent to the U.S. Department of Labor, Administrator, Wage and Hour Division, Room S-3502,
200 Constitution Avenue, N.W., Washington, D.C. 20210. DO NOT SEND THE COMPLETED FORM TO
THIS OFFICE.




                                                                                                    Form WH-1481
                                                                                                    Revised:April 2011