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The Testing Process

Drug testing involves much more than having a donor provide a sample in a cup. There are a lot of moving parts, and if even one part gets hung up, the entire process comes to a halt. Some delays are avoidable, however, a lot of times the test needs to go through its process.

To help you understand the testing process better, we broke down the process in three main parts of the process: collection sites, laboratory, and medical review officer.  No matter how, or why, you or an employee came in to be tested, this process is similar across industries.

CleanFleet knows the importance of getting results to employers as soon as possible. We have a dedicated team that mitigates avoidable delays and keeps employers informed of where tests are in their processes.

If you need help managing the testing process, click here.

Collection Sites Process:

  • • Verifying your Identity: The first step in the collection process starts with the collector verifying your identity by asking for a current valid photo ID (such as driver’s license, passport, employer issued picture ID, etc.).
  • • Prepare to give the Urine Specimen: The collector will ask you to remove any unnecessary garments and empty your pockets (you may retain your wallet). After instructing you to wash and dry your hands, the collector will select or have you select a sealed collection kit and open it in your presence.
  • • After Giving the Urine Specimen: When you are done, the collector will check the temperature and color of the urine (checking for adulteration of the specimen). In your presence, the collector will pour the urine into two separate bottles, seal them with tamper-evident tape, and then ask you to sign the seals after they have been placed on the bottles.
  • • Completing the Forms:
    • • The collector will then ask you to provide your name, date of birth, and daytime and evening phone numbers on the Medical Review Officer copy of the Federal Drug Testing Custody and Control Form (CCF).
    • • Next, collector will complete necessary documentation on the Test Facility copy of the CCF to demonstrate the chain of custody (i.e. handling) of the specimen. Then collector will give you the Employee Copy of the CCF and may suggest you list any prescription and over-the-counter medications you may be taking on the back of your copy of the CCF (this may serve as a reminder for you in the event the MRO calls you to discuss your test results).
    • • The last step for the collector is to package and ship both sealed bottles and completed CCF to a U.S. Health and Human Services (HHS) certified testing laboratory as quickly as possible.
  • • Not enough urine specimen?
    • • If you are unable to provide enough urine for the lab to analyze (45 mL of urine for DOT regulations) on the first attempt, the time will be noted, and you will be required to remain in the testing area under the supervision of the collection site personnel, their supervisor, or a representative from your company. Leaving the testing area without authorization may be considered a refusal to test.
    • • Next, you will be urged to drink up to 40 oz. of fluid, distributed reasonably over a period of up to three hours and asked to provide a new specimen (into a new collection container).
    • • If you do not provide a sufficient specimen within three hours, you must obtain a medical evaluation within five days to determine if there is an acceptable medical reason for not being able to provide a specimen. If it is determined that there is no legitimate physiological or pre-existing psychological reason for not providing a urine specimen, it will be considered a refusal to test if testing under the DOT.

Laboratories Process:

  • • Laboratories receive thousands of specimens each night from couriers and shipping companies like FedEx. Each specimen is then entered into the system and placed into a batch. Lab technicians review all chain of custody forms to make sure each chain does not have missing information. When it is determined that a chain isn’t complete, the lab then determines whether the flaw is correctable or fatal.
  • • If one of the seven fatal flaws are committed, the test is canceled and reported to the MRO as a fatal flaw. One example of a fatal flaw is when the collector does not print their name and sign the chain.
  • • In the case of a correctable flaw, the lab sends a memorandum of record (or affidavit) to the collector to be completed and sent back to the lab. An example of a correctable flaw is when a lab is waiting for a wet signature on the chain of custody form. The lab cannot proceed with testing the sample until they receive the completed memorandum, which delays the overall resulting times.
  • • Once all the correct records and signatures are received, the specimen then goes through an initial base screen test. If the results of this screening is negative, no further testing is needed and the negative result will be reported quickly.
  • • However, if there is any trace of drugs in that initial screen’s sample, the sample is then GCMS testing (Gas Chromatography – Mass Spectrometry). Sometimes this test doesn’t even produce affirmative negative or positive result of the sample. If it does, the results are reported.
  • • If not, the urine sample is broken down even more and sent back through the GCMS test again, and this process is repeated until an affirmative negative, positive, negative-dilute, or positive-dilute result is given.
  • • If no true result is affirmed in this GCMS process, the test must be canceled. Once canceled, the MRO can direct a retest (especially if a negative result is needed for a pre-employment drug test in the hiring process) or cancel a retest because no cheating was found or it’s too late to get a result after a reasonable suspicion or post-accident drug test.
  • Medical Review Officer Process:

    • • Once a donor’s sample is sample is tested by a laboratory, the result is sent to a Medical Review Officer (MRO) for review.
    • • Step 1: MRO Attempts To Reach The Donor 3 times in the first 24 hours. If the MRO cannot make contact with the donor, the MRO notifies the donor’s employer that the MRO needs to speak with the donor. The employer’s DER (Designated Employer Representative) then must make 3 attempts (text, email, phone) to reach the donor in 24 hours, documenting each attempt.
      • • If the DER makes contact with the donor, the DER notifies the MRO that contact has been made, and the donor has 72 hours to contact MRO back. If there is no contact back to the MRO by the donor within the 72 hours, the MRO releases the result as is to the employer.
      • • If the DER cannot make contact with the donor about contacting the MRO, the MRO must hold the result for 10 days before releasing it to the employer. Be sure to note that the employer has a role to play before the results are submitted to the company’s DER.
    • • Step 2: The MRO/Donor Interview where the MRO determines whether the donor wants to discuss the test result. In making this contact, the MRO must explain to the donor that, if he/she declines to discuss the result, the result will be reported as a positive or refusal to test because of adulteration or substitution, as applicable.
      • • The MRO must tell the driver that the laboratory has determined that the donor’s test result was positive, adulterated, substituted, or invalid, as applicable and which drugs his/her specimen tested positive for or the basis for the finding of adulteration or substitution.
      • • The MRO must explain that, if further medical evaluation is needed for the verification process, the driver must comply with the MRO’s request for this evaluation and that failure to do so is equivalent to expressly declining to discuss the test result.
      • • If there is no prescription or medical reason for the positive test, the MRO verifies the positive result.
      • • If the donor claims to be using a prescription, the donor has 5 days to present the prescription to the MRO. The MRO then contacts the pharmacy or prescribing physician to verify the prescription and that dosage prescribed is consistent with the levels found in the donor’s sample. If the prescription is validated the MRO will report a negative result to the employer.

Want help with this process and managing your drug testing program? All Consortium Members include best-in-class consortium management in every stage of the drug testing process:


1. Random Selections Process

  • We ensure DOT compliance of managing pools of individuals governed by the Department of Transportation (DOT) to meet the minimum testing percentage requirements, currently at least 25% of most DOT governed employees in a testing pool must be randomly tested for drugs while 10% need to be tested for alcohol by the end of the testing year
  • We take the job of managing DOT testing seriously as each individual company depends upon the group to follow through with their drivers to meet the testing requirements
  • Our staff works tirelessly to ensure each company’s Designated Employer Representative (DER) is informed of driver selections and assists them in tracking which drivers have been tested and who have not
  • • We help find near-by collection sites across the nation.

2. Testing Process of Collection Site, Lab, and MRO

  • Calling collection site to make sure they have the right gender staff for an observed collection or that they have a Breath Alcohol Test equipment on site
  • • We then authorize the drug test and make sure forms are filled out correctly
  • • We send the info over to the employer DER and the collection site
  • • As soon as we know the donor went in, we get paperwork and make sure specimen is sent to the lab, that the lab received the specimen, and that the lab has all the required documents needed
  • • If there is a memorandum or correction needed, we make sure the collection site fixes any issues
  • • We call the lab daily until the test gets done
  • • If there is a positive test reported, we make sure the MRO process is handled as efficiently as possible

3. Quality Assurance

  • • We work with SAMHSA Certified Labs to ensure the highest accuracy in every test
  • • Members may choose to have a Medical Review Officer to review positive test results
  • • We ensure all results are legally defensible in the court of law
  • • We handle the required drug test document retention
  • • We help prepare audit packages
  • • We do MIS reporting and CDL positive reporting, and other state reporting requirements
  • • We are your expert resource in all drug testing industry regulations and news
  • • We do not violate any regulations and do not allow our members to violate regulations
  • • We offer Drug & Alcohol Policy Development and DER and Supervisor Training for our members

Join our best-in-class consortium/TPA today or learn more by filling out the form below.