Homepage Blank Arkansas Atc R4 Form
Outline

The Arkansas ATC R4 form plays a crucial role in ensuring that employees of tobacco-selling establishments understand and comply with state laws regarding tobacco sales. This form is specifically designed for employees to acknowledge their responsibilities when it comes to selling tobacco products. Each employee must read, initial, and sign the document upon their employment and before they can sell any tobacco items. The form outlines key prohibitions, such as selling tobacco products to anyone under 18 years old or knowingly allowing these products to be provided to minors. It also emphasizes that selling single cigarettes or less than a full pack is not permitted. Additionally, employees are made aware of the potential legal consequences of violating these laws, which can include fines and criminal charges. The completed form must be kept on file at the store, ensuring it is accessible for inspection by Arkansas Tobacco Control officials at any time. This proactive measure not only protects minors but also helps maintain compliance with state regulations, fostering a responsible tobacco retail environment.

Sample - Arkansas Atc R4 Form

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 Date Signed
FORM ATC R-4 02/2020) (All blank lines on this form must contain information)
DFA - ARKANSAS TOBACCO CONTROL
101 E. Capitol Ave., Suite 401
Little Rock, AR 72201
Phone: (501) 682-9756
Fax: (501) 682-9760
https://www.atc.arkansas.gov
State of Arkansas
Department of Finance
And Administration

Form Information

Fact Name Details
Purpose The Arkansas ATC R4 form is used for Tobacco Server Awareness, ensuring employees understand their responsibilities regarding tobacco sales.
Initials Requirement Each employee must initial each section of the form, confirming their understanding of the rules before selling tobacco products.
Age Restrictions Employees cannot sell tobacco products to anyone under 18 years of age, as mandated by A.C.A. § 5-27-227.
Inspection Compliance The form must be kept on file at the store and be accessible for inspection by Arkansas Tobacco Control employees at any time.
Penalties for Violations Violating the age restriction can lead to criminal charges and fines up to $100 per violation, along with local court costs.
Signature Requirement Employees must sign the form to certify their understanding of the rules and agree to comply with state laws and store policies.

Detailed Guide for Filling Out Arkansas Atc R4

Completing the Arkansas ATC R4 form is essential for compliance with state regulations regarding tobacco sales. Each employee must fill out this form upon employment and before selling any tobacco products. The form must be kept on file and accessible for inspections.

  1. Obtain the Arkansas ATC R4 form from your employer or download it from the Arkansas Tobacco Control website.
  2. Read through the entire form carefully to understand the requirements and prohibitions related to tobacco sales.
  3. In the designated sections, each employee must initial each statement to indicate understanding and agreement.
  4. Sign the form where indicated, confirming that you have read and understood the statements.
  5. Provide the date you signed the form in the specified area.
  6. Print your name clearly in the section provided for the employee's printed name.
  7. Enter the date you began employment in the designated space.
  8. Have the store owner, manager, or supervisor sign the form to verify that the employee has completed it.
  9. Ensure the supervisor includes the date they signed the form.
  10. Return the completed form to your employer for filing and record-keeping.

Obtain Answers on Arkansas Atc R4

  1. What is the Arkansas ATC R4 form?

    The Arkansas ATC R4 form is a Tobacco Server Awareness Form. It is required for employees who work in establishments that sell tobacco products. This form ensures that employees understand the laws regarding the sale of tobacco, especially concerning age restrictions.

  2. Who needs to fill out the ATC R4 form?

    Every employee who will sell tobacco products must fill out the ATC R4 form. This includes cashiers and anyone else involved in the sale of tobacco items. It must be completed upon employment and before any tobacco sales take place.

  3. What should employees do with the ATC R4 form after filling it out?

    Once completed, the form should be kept on file at the store. It must be easily accessible to any employee present and available for inspection by Arkansas Tobacco Control officials at any time.

  4. What are the key responsibilities outlined in the ATC R4 form?

    • Employees must not sell tobacco products to anyone under 18 years of age.
    • They must not sell tobacco products to individuals 18 or older if they know those products will be given to someone under 18.
    • Single cigarettes or less than a full pack cannot be sold.
  5. What are the consequences of violating the rules outlined in the ATC R4 form?

    If an employee sells tobacco products to a minor, they may face criminal charges. A violation can result in a fine of up to $100 per occurrence, along with local court costs.

  6. How often can a store be inspected for compliance?

    Stores can be inspected at any time to ensure they are following state laws regarding the sale of tobacco products to minors. This means that compliance is an ongoing responsibility for all employees.

  7. What does signing the ATC R4 form signify for the employee?

    By signing the ATC R4 form, the employee certifies that they have read and understood the responsibilities outlined in the document. They agree to adhere to state laws and store policies regarding tobacco sales.

  8. Can employers contact Arkansas Tobacco Control regarding an employee's compliance?

    Yes, by signing the form, employees consent to allow current or potential employers to contact Arkansas Tobacco Control. This can help verify if the employee has received any citations for violations related to tobacco sales.

Common mistakes

Filling out the Arkansas ATC R4 form is crucial for compliance with tobacco laws. However, many individuals make common mistakes that can lead to complications. One frequent error is failing to initial each section. Each employee must acknowledge their understanding of the rules by initialing. Skipping this step can result in the form being incomplete, which may lead to issues during inspections.

Another mistake often seen is not signing and dating the document. The form requires both the employee's signature and the date they signed. Without this information, the form lacks validity. This can raise questions about when the employee was informed of the regulations, potentially leading to legal repercussions.

People sometimes overlook the importance of ensuring that the printed name of the employee is clearly written. Illegible handwriting can create confusion and may lead to difficulties in identifying the employee in the future. This simple oversight can complicate matters if there are any disputes or inspections.

Some employees may also fail to understand the implications of the regulations outlined in the form. It is vital to read and comprehend the statements regarding selling tobacco products. Ignorance of the law does not excuse violations. Therefore, employees should take the time to understand what they are agreeing to when they sign the document.

Finally, a common mistake involves not keeping the completed form accessible at the store. The regulations state that the form should be available for inspection by any employee of Arkansas Tobacco Control. If the form is not readily available, it can result in fines or penalties for the store. Keeping the form organized and accessible is essential for compliance.

Documents used along the form

The Arkansas ATC R4 form is a critical document for tobacco retailers in Arkansas, ensuring compliance with state laws regarding the sale of tobacco products. Along with this form, several other documents are often utilized to support compliance and operational standards. Below is a list of these important forms and documents.

  • Tobacco Server Awareness Training Certificate: This certificate verifies that employees have completed a training program focused on responsible tobacco sales. It is essential for ensuring that staff are knowledgeable about age restrictions and other legal requirements.
  • Employee Acknowledgment Form: This form confirms that employees have read and understood the store's policies regarding tobacco sales. It serves as a record of their commitment to adhering to these policies.
  • Daily Sales Log: Retailers often maintain a log of all tobacco sales. This document helps track compliance with age restrictions and can be useful during inspections by regulatory authorities.
  • Inspection Report: This report is generated during inspections conducted by Arkansas Tobacco Control. It outlines any violations found during the inspection and is crucial for retailers to address compliance issues promptly.
  • Incident Report Form: In the event of a violation or a customer complaint regarding tobacco sales, this form documents the incident. It helps the retailer manage issues effectively and provides a record for future reference.

Utilizing these forms and documents alongside the Arkansas ATC R4 form can help ensure that tobacco retailers operate within the legal framework and maintain responsible sales practices. Keeping these documents organized and accessible is essential for compliance and the overall success of the business.

Similar forms

  • Employee Handbook: Similar to the Arkansas ATC R4 form, an employee handbook outlines the policies and procedures employees must follow. It serves as a guide for acceptable behavior and expectations within the workplace.
  • Training Acknowledgment Form: Like the ATC R4, this document confirms that employees have received training on specific topics, such as safety protocols or compliance issues. It often requires signatures to verify understanding.
  • Non-Disclosure Agreement (NDA): This agreement, while focused on confidentiality, shares a common purpose with the ATC R4 in that it ensures employees understand and agree to specific regulations and responsibilities related to their role.
  • Compliance Certification Form: Much like the ATC R4, this form is used to verify that employees are aware of and will adhere to legal requirements in their work environment, ensuring compliance with relevant laws.
  • Safety Training Record: This document records that employees have completed safety training, similar to how the ATC R4 ensures employees are informed about tobacco sales laws. Both emphasize the importance of training and compliance.
  • Code of Conduct Agreement: This agreement outlines acceptable behavior and responsibilities within the workplace, paralleling the ATC R4 in its aim to ensure employees understand their obligations and the consequences of violations.

Dos and Don'ts

When filling out the Arkansas ATC R4 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do during this process.

  • Do read the entire form carefully before starting to fill it out.
  • Do ensure that all employees initial each section as required.
  • Do provide accurate information regarding the employee's name and date of employment.
  • Do keep the completed form on file at the store for easy access.
  • Do ensure the form is available for inspection by Arkansas Tobacco Control employees.
  • Don't leave any sections of the form blank; all parts must be completed.
  • Don't allow any employee to sign the form without fully understanding its content.
  • Don't submit the form without the necessary signatures from the employee and the supervisor.
  • Don't forget to date the form when it is signed by the employee.
  • Don't ignore the legal implications of selling tobacco products to minors.

Misconceptions

Understanding the Arkansas ATC R4 form is essential for employees working in tobacco sales. However, several misconceptions exist about this form. Here are seven common misunderstandings:

  • The form is optional for employees. Many believe that completing the ATC R4 form is not mandatory. In reality, each employee must fill it out before selling tobacco products.
  • Only new employees need to sign the form. Some think that only new hires are required to complete the form. However, all employees must sign it upon employment, regardless of their tenure.
  • The form is only for tobacco retailers. It's a common belief that the ATC R4 form applies solely to retail outlets. In fact, any establishment that sells tobacco products must comply with this requirement.
  • Initialing the form is just a formality. Some view the initialing of each section as a mere formality. Each initial indicates understanding and agreement with the regulations outlined in the form.
  • Violations only affect the store owner. Many employees think that any violations will only impact the store owner. In truth, employees can face criminal charges and fines for selling to minors.
  • Keeping the form on file is not necessary. There is a misconception that the form does not need to be readily accessible. In fact, it must be kept on file and available for inspection at all times.
  • Signing the form is the end of the responsibility. Some believe that signing the form absolves them of further responsibility. However, employees must consistently adhere to state laws and store policies regarding tobacco sales.

By clarifying these misconceptions, employees can better understand their responsibilities and the importance of compliance with the Arkansas Tobacco Control regulations.

Key takeaways

Here are some key takeaways about filling out and using the Arkansas ATC R4 form:

  • Purpose: The form is used to ensure that employees understand their responsibilities regarding the sale of tobacco products.
  • Initials Required: Each employee must initial each section of the form to confirm their understanding.
  • Signature and Date: Employees must sign and date the form upon employment and before selling tobacco products.
  • Retention: The completed form must be kept on file at the store and accessible at all times.
  • Inspection: The form should be available for inspection by any employee of Arkansas Tobacco Control.
  • Age Restrictions: Employees must not sell tobacco products to anyone under 18 years of age.
  • Prohibited Sales: Selling single cigarettes or less than a full pack is not allowed.
  • Legal Consequences: Violating age restrictions can lead to criminal charges and fines.
  • Compliance Checks: Stores may be inspected at any time to ensure compliance with state laws.
  • Employer Contact: Employees consent to their employers contacting Arkansas Tobacco Control regarding any violations.