Pre-employment drug and alcohol testing
Employers test for drugs and alcohol to meet legal requirements and to keep workplaces safe. How a test is done, who reviews the result and what the employee can expect depend on whether the job is covered by federal Department of Transportation (DOT) rules.
DOT and non-DOT testing
DOT-regulated testing
Employers of safety-sensitive transportation workers follow 49 CFR Part 40, which sets how specimens are collected, tested and reported. DOT drug tests screen for marijuana, cocaine, amphetamines, opioids and phencyclidine (PCP). DOT alcohol testing uses breath testing, and an alcohol concentration of 0.02 or higher removes the employee from safety-sensitive duty.
Non-DOT testing
Other employers set their own policy, including which substances are tested and when. A written policy that employees see in advance protects everyone.
When testing happens
Common triggers are pre-employment, random, post-accident, reasonable suspicion, return-to-duty and follow-up. DOT rules define when each one applies to covered employees, and employer policy covers the rest.
What a medical review officer does
A medical review officer (MRO) is a licensed physician with specialized training who reviews laboratory results. Before a non-negative result is reported to the employer, the MRO contacts the employee to ask about legitimate explanations, such as a prescription. That step exists so a valid prescription is not reported as a violation.
What to expect as an employee
Bring photo identification, and tell the collector about prescription medicines if asked. Keep a record of what you take. Collection follows set steps for identity, specimen handling and chain of custody. If you have questions about a result, you can discuss them with the MRO.
Which tests are available where
Services differ by clinic. Call the clinic nearest you to confirm which tests, panels and hours are available before you or an employee go.
Fewer injuries means fewer post-accident tests, so see workplace injury prevention. Testing is one part of occupational medicine at Nova.
This page is general information. It is not medical or legal advice and does not replace the rules that apply to your workplace.
References
About the clinical team behind this page
Dr. Arnaldo Manuel Mora is Medical Director and leads clinical governance at Nova. His background is in internal and occupational medicine. He oversees diagnostic intake, baseline laboratory review and the safety standards that apply before any prescription therapy, including pharmacy sourcing and contraindication screening as described in our safety guide.
Dr. Pelham Williams IV is Regional Medical Director for Nova’s Southeast region, based in Atlanta. His practice centers on the evaluation and non-operative management of musculoskeletal and work-related injuries, including acute joint injuries and repetitive-strain problems, and he reviews content on occupational injury and sports injury diagnosis.
Medical disclaimer: The information on this site is for education and does not replace a consultation, diagnosis or treatment. Full credentials are on our physicians and clinical governance page.
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Individual results vary and no outcome is guaranteed. This page is general information, not medical advice.