This hub is for employers/HR, safety-sensitive & DOT roles, healthcare/industrial workers, and job candidates who need documented testing for drug & alcohol, immunity/titers, TB screening, and exposure monitoring.
Core options include urine/oral fluid/blood screens with confirmatory GC/MS or LC-MS/MS, Breath Alcohol, EtG/EtS and PEth for alcohol, MMR/VZV/Hep B titers, IGRA TB tests, and heavy-metal surveillance. Results support hiring/placement, return-to-duty, fit-for-work, and regulatory compliance.
What It Tests
Employment testing spans multiple categories:
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Drug & Alcohol: Urine, oral fluid, hair, breath, blood/serum, EtG/EtS (urine) for recent alcohol, and PEth (blood) for patterned drinking. Immunoassays screen; non-negatives are presumptive until GC/MS or LC-MS/MS confirmation.
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Immunity & Titers: Measles/Mumps/Rubella (MMR) IgG, Varicella IgG, Hepatitis B surface antibody (anti-HBs) to document immunity for roles like healthcare.
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TB Screening: QuantiFERON-TB Gold Plus or T-SPOT.TB IGRAs (preferred for prior BCG-vaccinated workers).
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Exposure Monitoring: Lead ± ZPP, mercury, cadmium, chromium (hexavalent) urine, arsenic urine speciation, plus role-specific baseline labs (e.g., CBC/CMP/LFTs).
Key Tests
| Test |
Also Called (Synonyms) |
What It Measures |
Typical Prep |
Specimen |
Turnaround |
Related Panels |
Use Type |
Notes (COC/MRO, windows, thresholds) |
| Urine 5-Panel (SAMHSA) |
“SAMHSA 5” |
Amphetamines, Cocaine (BE), Marijuana (THC-COOH), Opiates, PCP |
Normal hydration; bring ID |
Urine |
Same day–2 d |
Pre-Employment; DOT |
Compliance / Screening |
Use COC MRO for regulated programs; recent–subacute window (class-dependent) |
| Urine 10-Panel (Expanded) |
Benzos, Barbs, Methadone, etc. |
Broader drug classes incl. sedatives |
As above |
Urine |
Same day–2 d |
Non-DOT |
Compliance / Screening |
Wider coverage for non-DOT policies |
| Expanded Opioids Fentanyl |
Oxy/Hydrocodone families; Fentanyl/Norfentanyl |
Semi-synthetic & synthetic opioids |
As above |
Urine |
1–3 d |
Pain/MAT |
Screening / Monitoring |
Addresses overdose-era risks; recent–few days |
| |
|
|
|
|
|
|
|
|
| Serum/Whole-Blood Ethanol |
— |
Blood alcohol level |
None unless specified |
Blood |
Rapid–1 d |
Alcohol Panel |
Clinical / Confirmation |
Short window (hours) |
| Urine EtG/EtS |
Ethyl glucuronide/sulfate |
Recent alcohol exposure |
Normal hydration |
Urine |
1–2 d |
Alcohol Monitoring |
Monitoring / Clinical |
~24–72 h window varies with intake |
| PEth (Blood) |
Phosphatidylethanol |
Patterned alcohol use |
— |
Blood (DBS/venous) |
2–5 d |
Alcohol Monitoring |
Monitoring / Clinical |
~2–4 weeks; intake-dependen |
| GC/MS or LC-MS/MS Confirmation |
Confirmatory testing |
Confirms screen positives |
Follows screen |
Urine/other |
1–3 d |
Add-on |
Confirmation |
Required before reporting non-negative in programs |
| Measles/Mumps/Rubella IgG |
MMR IgG |
Immunity documentation |
None |
Blood |
1–3 d |
Healthcare Clearance |
Compliance / Clinical |
Report immune vs non-immune |
| Varicella-Zoster Virus IgG |
VZV IgG |
Chickenpox immunity |
None |
Blood |
1–3 d |
Healthcare Clearance |
Compliance / Clinical |
Report immune vs non-immune |
| Hep B Surface Antibody (quant) |
anti-HBs (mIU/mL) |
Hep B immunity |
None |
Blood |
1–3 d |
Healthcare Clearance |
Compliance / Clinical |
Protective ≥10 mIU/mL(document level) |
| QuantiFERON-TB Gold Plus |
IGRA |
Latent TB screening |
None |
Blood |
1–3 d |
TB Screening |
Compliance / Clinical |
Positive/negative/indeterminate; not affected by BCG |
| T-SPOT.TB |
IGRA |
Alternative latent TB test |
None |
Blood |
1–3 d |
TB Screening |
Compliance / Clinical |
Useful in some immunocompromised settings |
| Blood Lead ± ZPP |
— |
Occupational lead exposure |
Follow lab guidance |
Blood |
1–3 d |
Exposure Monitoring |
Compliance / Clinical |
Compare to program thresholds; periodic surveillance |
| Mercury (blood/urine) |
— |
Mercury exposure |
Follow kit; timing varies |
Blood/Urine |
2–4 d |
Exposure Monitoring |
Compliance / Clinical |
Specimen type depends on exposure |
| Cadmium (blood/urine) |
— |
Cadmium exposure |
Follow kit |
Blood/Urine |
2–4 d |
Exposure Monitoring |
Compliance / Clinical |
Periodic testing per role |
| Chromium (blood) (urine) |
— |
Cr exposure |
none |
Urine |
2–4 d |
Exposure Monitoring |
Compliance / Clinical |
Role-specific limits apply |
| Arsenic (urine, speciation) |
Inorganic/organic As |
Arsenic exposure profile |
Avoid seafoodbefore test (per lab) |
Urine |
2–5 d |
Exposure Monitoring |
Compliance / Clinical |
Speciation distinguishes dietary sources |
| Baseline CBC CMP |
— |
General health context |
Often non-fasting |
Blood |
Same day–1 d |
Baseline |
Clinical |
Include if required by policy/role |
When to Test
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Pre-employment / onboarding (baseline screening & documentation).
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Random, reasonable suspicion, and post-accident (safety-sensitive programs).
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Return-to-duty & follow-up schedules (DOT/non-DOT).
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Annual/periodic surveillance (healthcare TB & immunity; industrial exposure).
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Placement changes or international assignments (immunity/TB paperwork).
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After exposure incidents (needle-stick, chemical spill—follow employer protocol).
How to Prepare
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Identification & paperwork: Bring government ID; follow COC steps for compliance collections.
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Medication/supplement disclosure: Provide Rx/OTC list; an MRO may verify legitimate prescriptions.
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Hydration: Drink normally—over-hydration can cause dilute urine.
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Oral fluid & breath alcohol: Avoid food/drink/tobacco/alcohol-containing mouthwash for the kit-specified interval.
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IGRA/Titers: No fasting needed.
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Heavy metals: Follow test-specific prep (e.g., avoid seafood before arsenic speciation).
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No tampering: Adulterants/substitution are prohibited; labs run specimen validity checks (creatinine, specific gravity, pH, oxidants).
Interpreting Results
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Screen vs confirm: Immunoassay positives are presumptive until GC/MS or LC-MS/MS confirmation.
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COC/MRO: Regulated programs require chain-of-custody documentation and MRO review.
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Detection windows ≠ impairment: Positives show presence above a cutoff, not on-site impairment.
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Immunity titers: Report immune vs non-immune for MMR/VZV; anti-HBs ≥10 mIU/mL is typically protective for Hep B.
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TB IGRAs: Report positive/negative/indeterminate; interpret with risk evaluation and policy.
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Exposure labs: Compare to program thresholds; follow employer protocol for repeat testing or temporary removal from exposure.
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Privacy: Results are disclosed per program policy and applicable law (e.g., MRO to employer for compliance tests).
Related Programs / Use Cases
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Pre-employment & onboarding
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DOT & safety-sensitive roles
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Healthcare worker clearance (TB & immunity)
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Industrial/OSHA exposure monitoring
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Return-to-duty & follow-up testing
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International/academic placements (immunity documentation)
Bundles & Panels
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Pre-Employment Base Panel – Includes 3 tests covering 9 biomarkers for foundational pre-hire screening (core health metrics applicable to employment).
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Pre-Employment Comprehensive Panel – Contains 6 tests and 13 biomarkers expanding upon basic screening with additional indicators relevant to health compliance.
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10-Panel Drug Test – Focuses on detecting 10 common drug classes in urine; a widely used employer-required toxicology screen.
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Employer Wellness Screening Panel 4 – Encompasses 3 tests and 61 biomarkers covering comprehensive wellness markers beyond pre-hire basics.
FAQs
What’s the difference between DOT and non-DOT testing?
DOT tests follow federal rules (e.g., 49 CFR Part 40) with COC/MRO requirements. Non-DOT programs follow employer policy and state law.
Do I need chain-of-custody and an MRO?
Yes for regulated compliance testing. Clinical panels without COC/MRO typically don’t meet those requirements.
How long do drugs or alcohol stay detectable?
Varies by substance, dose/frequency, metabolism, specimen type, and cutoffs. Hair ≈ months; urine/oral fluid ≈ hours–days; EtG/EtS ≈ hours–days; PEth ≈ weeks.
IGRA vs PPD—what should I use for TB?
Most employers prefer IGRAs (e.g., QuantiFERON-TB Gold or T-SPOT.TB), especially for BCG-vaccinated workers.
What anti-HBs level counts as immune for Hep B?
A quantitative anti-HBs ≥10 mIU/mL is generally considered protective.
Can I use vaccine records instead of titers?
Often yes, depending on employer policy. Some roles still require titers for documentation.
What if my urine is dilute, invalid, or adulterated?
Programs usually require recollection (sometimes observed) per policy.
Do I need to fast for these tests?
Usually no. Follow any kit-specific instructions (e.g., oral fluid/breath alcohol).
Will prescriptions cause a positive result?
Some medications can trigger presumptive positives. The MRO reviews legitimate prescriptions for compliance tests.
Who can see my results?
Disclosure follows policy and law—e.g., MRO communicates to the employer for compliance testing; clinical results go to you/your ordering clinician.
References
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SAMHSA — Workplace drug testing guidelines (screening/confirmation standards)
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U.S. DOT (49 CFR Part 40) — Drug & alcohol testing procedures for transportation employees
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CDC/ACIP — Healthcare personnel immunization & anti-HBs guidance; TB IGRA resources
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OSHA/NIOSH — Heavy-metal and exposure surveillance guidance
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ASAM — Appropriate use of drug testing in clinical addiction medicine
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ARUP Consult / Mayo Clinic Labs — Test overviews, detection windows, titer interpretations
Last reviewed: SEPTEMBER 2025 by Ulta Lab Tests Medical Review Team
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