Frequently Asked Questions

Medical Review Officer (MRO) - A Medical Review Officer (MRO) is a person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results. The MRO receives the laboratory drug test results from the lab and reports the results to the employer. Many TPA’s have in house MRO’s working for them.  For Federal Programs, DOT programs and under many State laws and State law programs the MRO must be trained, qualified and certified by a nationally-recognized MRO certification board or subspecialty board for medical practitioners in the field of medical review of DOT-mandated drug tests.  

The MRO is required for testing for Federal Agency employees, DOT testing programs and under many State laws and State law programs.  It is a best practice to use an MRO for all workplace laboratory drug testing.

TPA stands for third party administrator and C/TPA stands for Consortium/ third party administrator.  There are terms used to describe those in the business of drug and alcohol testing programs.

The TPA puts together all of the services employers need to manage a drug testing program including collectors, collection sites, BAT’s, STT’s, Laboratories, Medical Review Officers (MRO’s), SAP’s, EAP Programs, random testing programs and overall drug testing program management.

The term Consortia/Third Party Administrator was coined by DOT with the rewrite of 49 CFR Part 40 back in 2001.  C/TPA’s providing DOT drug & alcohol testing services should be intimately familiar with program 49 CFR Part 40, read it over and read it over again. 

In 49 CFR Part 40 the C/TPA is defined as:  A service agent that provides or coordinates the provision of a variety of drug and alcohol testing services to employers.  C/TPAs typically perform administrative tasks concerning the operation of the employers' drug and alcohol testing programs.  This term includes, but is not limited to, groups of employers who join together to administer, as a single entity, the DOT drug and alcohol testing programs of its members.   

The term consortium came about as a result of smaller companies needing TPA services to effectively comply with the DOT drug and alcohol regulations, specifically random testing.

The TPA puts together all of the services employers need to manage a drug testing program including collectors, collection sites, BAT’s, STT’s, Laboratories, Medical Review Officers (MRO’s), SAP’s, EAP Programs, random testing programs and overall drug testing program management.

During the testing process, collectors occasionally encounter disruptive, uncooperative, or obstructive donors whose actions or statements make clear they are refusing to participate in the test. Per §40.261(c) and §40.191(d), collectors are required to document and record actions they deem to be a refusal to test. This is usually done in the remarks section of the Alcohol Testing Form (ATF) (under Step 3) or Custody and Control Form (CCF) (under Step 2). Collectors are also required to advise the donor that failure to comply is a refusal to test.

Collectors often simply write “Refused” in the remarks section to indicate unacceptable behavior has occurred. Since in many cases it is the employer who makes the official ‘refusal’ designation and is responsible for assessing the documentation provided by the collector, a detailed and descriptive statement of events is necessary.

Short but descriptive narratives are essential, such as “donor did not provide a sufficient specimen and left the collection site before three hours elapsed,” “donor refused to empty their pockets” or “donor admitted their specimen was diluted with toilet water.” Collectors must not write only an employee “refused to test,” since this is too vague.

By making genuinely descriptive remarks, collectors assist the MRO, Designated Employee Representative (DER), or reviewing physician in their decision-making responsibilities.

Documentation of the events resulting in termination of the testing process is required to be included on the ATF and CCF. However, as the remarks section is relatively small, it is a good idea (but not required by Part 40) to include a supplemental account on a separate paper describing the circumstances, conversations, and any other information, and transmit documentation along with the relevant copies of the ATF and CCF.

Occasionally, there are cases in which both a DOT pre-employment and return-to-duty negative drug test result is required, prior to the performance of covered duties. Typically, DOT does not require redundant testing. Instead, only the more stringent test need be performed, which is the directly observed return-to-duty drug test. The employer must maintain in the employee’s secure file a memorandum providing details on the use of the negative return-to-duty test as evidence pre-employment testing requirements are being met. For the purposes of MIS reporting, employers should report the results of only the test(s) performed. Do not double-report a single return-to-duty test as both a return-to-duty test and a pre-employment test.

This person must have demonstrated the necessary knowledge, skills, and abilities by (1) regularly conducting DOT drug test collections for a period of at least one year; (2) conducting collector training under Part 40 for at least one year; or (3) successfully completing a “train the trainer” course. 

These are the qualifications a collector must meet to be able to monitor and evaluate a DOT collector’s proficiency demonstration - mock collections.

Qualification training must include instruction on (1) all steps necessary to complete a collection correctly and the proper completion and transmission of the Custody and Control Form (CCF); (2) problem collections such as shy bladder and attempts to adulterate a specimen; (3) fatal flaws, correctable flaws, and how to correct problems in collections; and (4) the collector’s responsibility for maintaining the integrity of the collection process, ensuring the privacy of employees being tested, ensuring the security of the specimen, and avoiding conduct or statements that could be viewed as offensive or inappropriate.

Proficiency demonstration consists of completing five consecutive error-free mock collections. The five mock collections must include two uneventful collection scenarios, one insufficient quantity of specimen scenario, one temperature out of range scenario, and one scenario where the donor refuses to sign the CCF and initial the specimen bottle tamper evident seal. These mock collections must be monitored and evaluated by a person that meets the DOT requirements to do so (see #3). This person must attest in writing that the mock collections were error-free.