The Arkansas ATC R4 form is a Tobacco Server Awareness Form that must be completed by employees at permitted outlets before they can sell tobacco products. This document ensures that employees understand their responsibilities under Arkansas law, particularly regarding the sale of tobacco to minors. It is crucial for compliance, as the form must be readily available for inspection by Arkansas Tobacco Control officials.
The Arkansas ATC R4 form plays a crucial role in ensuring that tobacco sales comply with state regulations. Designed for employees at permitted outlets, this form serves as a Tobacco Server Awareness document that must be completed upon hiring. Each employee is required to initial various sections, sign, and date the form before they are authorized to sell any tobacco products. The form outlines important responsibilities, emphasizing the prohibition of selling tobacco to individuals under 18 years of age, as mandated by Arkansas law. Additionally, it specifies that selling single cigarettes or smaller quantities is not allowed. This document is not merely a formality; it must be kept on file at the store, readily accessible for employees and subject to inspection by Arkansas Tobacco Control officials. Employees acknowledge their understanding of the legal implications of selling tobacco products, including potential fines for violations. By signing the ATC R4, employees commit to adhering to state laws and the store’s policies regarding tobacco sales, thereby promoting responsible practices in the retail environment.
The Arkansas ATC R4 form, also known as the Tobacco Server Awareness Form, is designed to ensure that employees working in tobacco-selling outlets understand the laws surrounding the sale of tobacco products. Each employee must read and acknowledge the responsibilities outlined in the form before they can sell any tobacco products. This helps prevent illegal sales to minors and promotes compliance with state regulations.
Every employee who will be selling tobacco products must sign the ATC R4 form. This includes cashiers and anyone else involved in the sale of tobacco. The form must be signed upon employment and before any tobacco sales take place. It is crucial that each employee initials each section of the form to confirm their understanding of the regulations.
If an employee sells tobacco products to anyone under the age of 18, they may face criminal charges. Violations can lead to fines of up to $100 per incident, in addition to any local court costs. The store itself may also be inspected to ensure compliance with the law, which could result in further penalties if violations are found.
The ATC R4 form must be kept on file at the store and should be easily accessible to any clerk or employee present. This ensures that the form can be reviewed by employees at any time and is available for inspection by representatives from Arkansas Tobacco Control. Proper storage and accessibility are vital for compliance and accountability.
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)
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When filling out the Arkansas ATC R4 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are five things you should and shouldn't do:
By adhering to these guidelines, you help maintain compliance with Arkansas Tobacco Control regulations and promote responsible selling practices within your store.
Failing to initial each section of the form. Each employee must provide their initials to confirm understanding of the rules.
Not signing and dating the document. It is essential for both the employee and the supervisor to sign and date the form to validate it.
Overlooking the requirement to keep the form on file. The completed form must be accessible at all times for inspection.
Neglecting to inform employees about the consequences of selling to minors. Employees must understand the legal implications of their actions.
Misunderstanding what constitutes a pack of cigarettes. Employees should know that a full pack consists of 20 or 25 cigarettes.
Failing to acknowledge the types of tobacco products covered. Employees should recognize that the term "other tobacco products" includes various forms, not just cigarettes.
Not being aware of the inspection policy. Employees should know that inspections can happen at any time to ensure compliance.
Ignoring the importance of reading the entire document. Every statement in the form is crucial for understanding responsibilities.
Forgetting to provide the printed name of the employee. This information is necessary for identification purposes.
Failing to communicate the potential fines for violations. Employees should be made aware of the financial penalties for non-compliance.