Form WH-1481 Notice to Examinee-Employee Polygraph Protection Act

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
the exemptions provided in sections 7(d), (e), and (f) of the Act. These exemptions are applicable to certain
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
Department of Labor regulations (29 C.F.R. §§ 801.22,
801.23, 801.24, and 801.25) require that you be given the
following information before taking a polygraph examination:
1. (a) The polygraph examination area [does] [does not]
contain a two-way mirror, a camera, or other device
through which you may be observed.
(b) Another device, such as those used in conversation
or recording, [will] [will not] be used during the
examination.
(c) Both you and the employer have the right, with the
other's knowledge, to record electronically the entire
examination.
2. (a) You have the right to terminate the test at any time.
(b) You have the right, and will be given the opportunity,
to review all questions to be asked during the test.
(c) You may not be asked questions in a manner which
degrades, or needlessly intrudes.
(d) You may not be asked any questions concerning:
Religious beliefs or opinions; beliefs regarding racial
matters; political beliefs or affiliations; matters
relating to sexual preference or behavior; beliefs,
affiliations, opinions, or lawful activities regarding
unions or labor organizations.
(e) The test may not be conducted if there is sufficient
written evidence by a physician that you are
suffering from a medical or psychological condition
or undergoing treatment that might cause abnormal
responses during the examination.
(f) You have the right to consult with legal counsel or
other representative before each phase of the test,
although the legal counsel or other representative
may be excluded from the room where the test is
administered during the actual testing phase.
3. (a) The test is not and cannot be required as a condition
of employment.
(b) The employer may not discharge, dismiss, discipline,
deny employment or promotion, or otherwise
discriminate against you based on the analysis of a
polygraph test, or based on your refusal to take such
a test without additional evidence which would
support such action.
(c) (1) In connection with an ongoing investigation, the
additional evidence required for an employer to
take adverse action against you, including
termination, may be (A) evidence that you had
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
under investigation.

4.

5.

6.

OMB No.: 1235-0005
Expires: xx/xx/201x

(2) Any statement made by you before or during the
test may serve as additional supporting
evidence for an adverse employment action, as
described in 3(b) above, and any admission of
criminal conduct by you may be transmitted to
an appropriate government law enforcement
agency.
(a) Information acquired from a polygraph test may be
disclosed by the examiner or by the employer only:
(1) To you or any other person specifically
designated in writing by you to receive such
information;
(2) To the employer that requested the test;
(3) To a court, governmental agency, arbitrator, or
mediator that obtains a court order;
(4) To a U.S. Department of Labor official when
specifically designated in writing by you to
receive such information.
(b) Information acquired from a polygraph test may be
disclosed by the employer to an appropriate
governmental agency without a court order where,
and only insofar as, the information disclosed is an
admission of criminal conduct.
If any of your rights or protections under the law are
violated, you have the right to file a complaint with the
Wage and Hour Division of the U.S. Department of Labor,
or to take action in court against the employer.
Employers who violate this law are liable to the affected
examinee, who may recover such legal or equitable relief
as may be appropriate, including, but not limited to,
employment, reinstatement, and promotion, payment of
lost wages and benefits, and reasonable costs, including
attorney's fees. The Secretary of Labor may also bring
action to restrain violations of the Act, or may assess civil
money penalties against the employer.
Your rights under the Act may not be waived, either
voluntarily or involuntarily, by contract or otherwise,
except as part of a written settlement to a pending action
or complaint under the Act, and agreed to and signed by
the parties.

I acknowledge that I have received a copy of the above notice,
and that it has been read to me.
__________________________________
(Date)

___________________________________
(Signature)

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 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 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 the exemptions provided in sections 7(d), (e),
and (f) of the Act. The information provided under this notice 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. This notice conforms to Appendix
A of the EPPA regulations, 29 C.F.R. § Part 801, 56 FR 9064, Mar. 4, 1991, 56 FR 14469, April 10, 1991.
Public reporting burden for this notice 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