The Arkansas Tobacco Server Awareness Form, known as the ATC R4 form, is a crucial document that ensures employees in tobacco-selling establishments understand their responsibilities under state law. Each employee must sign and date this form upon employment, confirming their commitment to comply with regulations regarding the sale of tobacco products. To ensure compliance and protect minors, it is essential to fill out this form accurately; click the button below to get started.
The Arkansas ATC R4 form is a crucial document for any employee involved in the sale of tobacco products within the state. Designed to ensure compliance with state laws, this form requires employees to acknowledge their responsibilities regarding the sale of tobacco. Each employee must initial and sign the form upon employment and prior to selling any tobacco items. The document outlines specific prohibitions, such as selling tobacco to anyone under 18 years of age or knowingly allowing such sales to occur. It also highlights the importance of maintaining a full pack of cigarettes for sale and clarifies what constitutes tobacco products. Additionally, employees are made aware of the potential legal consequences for violations, including fines and inspections by Arkansas Tobacco Control. The form serves as a commitment to uphold state regulations and store policies, ensuring that all employees understand the serious implications of non-compliance.
DFA - ARKANSAS TOBACCO CONTROL
State of Arkansas
101 E. Capitol Ave., Suite 401
Little Rock, AR 72201
Department of Finance
Phone: (501)
682-9756
And Administration
Fax: (501)
682-9760
https://www.atc.arkansas.gov
TOBACCO AND VAPOR SERVER AWARENESS FORM
Upon employment, all employees must initial each section, sign, and date this document before selling any tobacco, vapor, alternative nicotine, or e-liquid products. This form is to be kept on file at the store, be accessible to any clerk or employee present, and be available at all times for inspection by any employee of Arkansas Tobacco Control.
As an employee of a permitted outlet, I understand that there are certain things I am prohibited from doing and certain actions that I cannot allow to occur in the outlet. In accordance with Arkansas law and the rules of Arkansas Tobacco Control, I have read, initialed and acknowledged the following:
(Please initial below)
I will not sell cigarettes, tobacco products, vapor products, alternative nicotine products or e-liquid products
to anyone 21 years of age or older when I know the products will be provided to a person or persons under the
age of 21.
_______
I understand that cigarettes or “tobacco products” includes any substance that contains tobacco, including
but not limited to, cigarettes, cigars, smokeless tobacco, loose tobacco, hookah tobacco, shisha, and cigarette
papers.
I will not sell single cigarettes or any number of cigarettes less than a full pack (20 or 25 cigarettes packaged
together constitutes a pack) and I understand it is against the law to do so.
________
I understand that sales to anyone under the age of 21 can result in criminal charges being filed against me. I
understand that as a clerk, if I am found guilty of a violation of A.C.A. § 5-27- 227, I shall be subject to a fine up to
$100 per violation, plus local court costs.
I understand that this store may undergo inspection at any time to assess its compliance with the state law
regarding the sale of cigarettes, tobacco products, vapor products, alternative nicotine products or
e-liquid products to a minor under the age of 21.
I understand it is illegal to reuse or refill tobacco boxes with cigars, little cigars, cigarillos or any other tobacco product. Any person doing this can be charged with a Class D Felony.
By signing below, I hereby certify that I have read and fully understand the above statements. I agree to always follow state law and not to sell cigarettes, tobacco, vapor, alternative nicotine, or e-liquid products to minors. I further consent to allowing any current or potential employer to contact Arkansas Tobacco Control to determine if I have received any citations for violations of Title 5, Chapter 27 of the Arkansas Code.
Employee Signature
Date Signed
Printed Name of Employee
Date Entered Employment
Signature of Owner, Manager or Supervisor
FORM ATC R-4 02/2020)
(All blank lines on this form must contain information)
Completing the Arkansas Tobacco Control R4 form is essential for employees who sell tobacco products. This form must be filled out accurately and kept on file at the store. Employees should ensure they understand the regulations and acknowledge their responsibilities regarding tobacco sales.
After completing these steps, ensure that the form is stored in a location accessible to all employees. It may be subject to inspection by Arkansas Tobacco Control officials at any time.
The Arkansas ATC R4 form, also known as the Tobacco Server Awareness Form, is a document that employees at tobacco-selling outlets must complete upon employment. It ensures that employees are aware of the laws and regulations surrounding the sale of tobacco products in Arkansas.
Every employee working in a permitted outlet that sells tobacco products must fill out the ATC R4 form. This includes anyone who will be involved in the sale or handling of tobacco products.
The form requires the employee to initial various sections confirming their understanding of the laws regarding tobacco sales. It also requires the employee's signature, printed name, and the date they entered employment. Additionally, the store owner or manager must sign the form.
Keeping the ATC R4 form on file is crucial for compliance with Arkansas law. It must be accessible to employees and available for inspection by Arkansas Tobacco Control officials. This helps ensure that the outlet adheres to regulations regarding the sale of tobacco products.
Failure to comply with the regulations can lead to serious consequences. Employees can face criminal charges for selling tobacco to minors, with fines up to $100 per violation. Additionally, the store may face inspections and potential penalties for non-compliance.
The ATC R4 form outlines several prohibited actions, including:
The ATC R4 form should be completed by each new employee at the time of their hiring. If an employee leaves and a new one is hired, the new employee must fill out a fresh form.
Yes, the ATC R4 form can serve as a training tool for new employees. It provides essential information about the legal responsibilities associated with selling tobacco products, helping to ensure that employees understand their obligations from the start.
If an employee has questions about the ATC R4 form or its contents, they should speak with their supervisor or manager. It's important for employees to fully understand their responsibilities and the regulations before they begin selling tobacco products.
Neglecting to Initial Every Section: Each employee must initial each section of the form. Failing to do so can lead to misunderstandings about responsibilities and regulations.
Forgetting to Sign and Date: It's crucial to sign and date the document upon employment. Omitting this step can result in the form being considered incomplete and invalid.
Not Keeping the Form Accessible: The form must be kept on file at the store and accessible to all employees. If it's not readily available, it may cause issues during inspections.
Ignoring the Age Restrictions: Employees must understand that selling tobacco products to anyone under 18 is illegal. Misunderstanding this rule can lead to serious legal consequences.
Misunderstanding the Definition of Tobacco Products: The form specifies what constitutes tobacco products. Failing to recognize that items like herbal cigarettes are included can lead to violations.
Overlooking the Consequences of Violations: Employees should be aware that violations can result in fines and criminal charges. Ignoring this reality can lead to severe repercussions.
Not Acknowledging Inspection Rights: Employees must understand that inspections can occur at any time. Being unprepared for an inspection can create unnecessary complications.
The Arkansas ATC R4 form is an essential document for employees involved in the sale of tobacco products in Arkansas. However, there are several other forms and documents that often accompany it. Each of these documents plays a crucial role in ensuring compliance with state regulations and promoting responsible sales practices. Below is a list of related forms that you might encounter.
These documents collectively support the responsible sale of tobacco products and help maintain compliance with Arkansas regulations. Ensuring that all employees are familiar with these forms can create a safer and more compliant retail environment.
The Arkansas ATC R4 form is similar to the Employee Handbook that many businesses provide to their staff. An Employee Handbook outlines the company’s policies and procedures, including expectations regarding behavior and compliance with laws. Just like the ATC R4 form, it requires employees to acknowledge their understanding of the rules, often through a signature. Both documents serve as important references for employees, ensuring they are aware of their responsibilities and the consequences of non-compliance.
Another document comparable to the Arkansas ATC R4 form is the Compliance Training Certificate. This certificate is issued after employees complete training related to legal compliance, including age restrictions on selling tobacco products. Similar to the ATC R4, it includes an acknowledgment from the employee that they understand the training material. Both documents are essential for maintaining compliance and can be reviewed during inspections or audits.
The Tobacco Sales Training Acknowledgment is another document that shares similarities with the ATC R4 form. This acknowledgment is typically signed by employees who have completed a training program focused on responsible tobacco sales practices. Like the ATC R4, it requires employees to confirm their understanding of legal obligations, such as not selling to minors. Both documents reinforce the importance of adherence to state laws and help protect the business from potential legal issues.
The Age Verification Log is also akin to the Arkansas ATC R4 form. This log is used by retailers to document the verification of customers' ages before selling tobacco products. Both documents aim to prevent underage sales and require employees to be vigilant and proactive. While the ATC R4 focuses on employee acknowledgment of the rules, the Age Verification Log emphasizes the actions taken to comply with those rules.
Another related document is the Tobacco Compliance Inspection Report. This report is generated during inspections by regulatory agencies to assess compliance with tobacco laws. Similar to the ATC R4 form, it highlights the importance of following state regulations and can result in penalties if violations are found. Both documents serve as tools for accountability, ensuring that employees and businesses uphold the law.
Lastly, the Training Attendance Record is similar to the Arkansas ATC R4 form in that it tracks employee participation in compliance-related training sessions. This record confirms that employees have received necessary training on the sale of tobacco products, much like the ATC R4 form confirms their understanding of the rules. Both documents serve to demonstrate a commitment to compliance and can be critical during audits or inspections by regulatory bodies.
When filling out the Arkansas ATC R4 form, it is essential to follow specific guidelines to ensure compliance and accuracy. Here are five things you should and shouldn't do:
Understanding the Arkansas ATC R4 form is crucial for employees working in tobacco retail. However, several misconceptions often arise. Here are six common misunderstandings:
Being informed about these misconceptions can help employees navigate their responsibilities effectively and ensure compliance with Arkansas tobacco laws.
When filling out and using the Arkansas ATC R4 form, it is essential to keep the following key points in mind:
Adhering to these guidelines helps ensure compliance with Arkansas law and promotes responsible tobacco sales practices.