Ask X3What does 49 CFR 40.193 (What happens when an employee does not provide a sufficient amount of specimen for a drug test?) require?
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As Ask X3, here is what must happen when an employee does not provide a sufficient amount of specimen for a drug test, according to 49 CFR 40.193:
* Collector's Action (Another Opportunity): The collector must give the employee another opportunity to provide a sufficient specimen (45 mL for urine in a single void, or 2 mL for oral fluid in a single sampling). Following your instructions, the collector can use the same specimen type or switch to an alternate specimen collection (urine to oral fluid, or vice versa) performed by a qualified collector.
* If Switching to an Alternate Specimen: The collector must discard the insufficient specimen and its Custody and Control Form (CCF), start a new CCF with a remark noting the change, and begin the new collection following the appropriate section.
* If Continuing with Urine:
* The collector discards the insufficient specimen (unless out of temperature range or showing signs of tampering).
* The collector urges the employee to drink up to 40 ounces of fluid distributed over up to three hours, or until a sufficient specimen is provided. (Declining to drink is not a refusal). The collector documents the start and end times on the CCF Remarks line.
* If the employee refuses to try or leaves before completion, the collector discontinues the test, notes it on the CCF, and immediately notifies your Designated Employer Representative (DER). (You, the employer, decide if it is a refusal).
* If no sufficient specimen is provided within three hours, the collector discontinues the collection, notifies the DER, and discards all previously provided specimens (including any out of temperature range or tampered specimens), noting this on the CCF.
* If Continuing with Oral Fluid:
* If the donor cannot provide a specimen after 15 minutes using the device and states they could after drinking, the collector urges them to drink up to 8 ounces, waits an additional 10 minutes, and allows up to one hour total (or until a sufficient specimen is provided) in a monitored area. (Drinking is optional and declining is not a refusal).
* If a sufficient specimen is not provided within one hour, the collector discontinues the collection, notes it on the CCF, and immediately notifies the DER.
* Paperwork: The collector sends Copy 2 of the CCF to the Medical Review Officer (MRO) and Copy 4 to the DER within 24 hours or the next business day.
* Physician Evaluation: When informed that the employee failed to provide a sufficient specimen, you (the DER), after consulting with the MRO, must direct the employee to obtain an evaluation within five days from a licensed physician acceptable to the MRO who has expertise in the medical issues involved.
* MRO & Referral Physician Determination: The evaluating physician provides a written recommendation to the MRO stating whether a medical condition (an ascertainable physiological condition or medically documented pre-existing psychological disorder, excluding unsupported situational anxiety or dehydration) precluded the employee from providing a sufficient specimen:
* If a medical condition caused it: The MRO checks "Test Cancelled" on the CCF and signs/dates it.
* If there is no adequate basis for a medical condition: The MRO checks the "Refusal to Test" and "Other" boxes on the CCF, notes the reason, and signs/dates it.