Guest Blog Series: What Happens After a Positive Result

So you have a positive test result, and I am sure you are thinking, “Oh no, what now?! What are my next steps?” Well have no fear, Tomo is here! Whether you have a Department of Transportation drug or alcohol positive, or a Drug Free Workplace drug or alcohol positive, Tomo has you covered.

What Happens After a Positive Result

What is a positive result?

A positive result is a result that is deemed to have certain levels of substances and/or breath alcohol levels above the cutoffs checked by one of the following: the laboratory, the Medical Review Officer (MRO), or the collector.

How do I know when the result was deemed positive by the collector?

If your result is deemed positive by the collector, it is due to the fact that either your company’s Designated Employer Representative (DER) didn’t want to send the instant test to the lab for confirmation due to their company policy, or the donor chose not to pay to send the test to the lab for confirmation due to their own reasons. The other scenario is that it is a breath alcohol test where no lab or Medical Review Officer are ever involved.

How do I know when the result was deemed positive by the laboratory or from the MRO?

This will depend on your agreement established with Tomo Drug Testing. If your company set up an agreement to automatically send positives to the MRO, the final result would be determined from the MRO. (All DOT tests must always be sent to the MRO.) If your company has the agreement with Tomo Drug Testing that positives are not sent to the MRO, the laboratory would make the final determination of the positive result based on the confirmation test performed.

My employee has a Department of Transportation (DOT) positive drug or alcohol test. What are my responsibilities as the employer?

All responsibilities with regards to DOT positive drug and alcohol test results from the MRO, or a refusal of a DOT drug test, hold the following actions:

Whether the employer chooses to keep the employee on payroll or not, the donor must be given a phone number of a DOT-certified Substance Abuse Professional (SAP) who they can contact for help. (Please note: the donor can choose to use whichever SAP they prefer, but the employer is required to provide them with one phone number of a DOT SAP.)

The employee must be pulled immediately from any safety-sensitive functions they are performing on the job, as well as any vehicle they are driving if the combined gross weight is 26,0001 lbs or over.

How do I find a DOT-certified Substance Abuse Professional to provide to my employee?

Tomo will provide a list of contacts that you can use to find a local SAP for your employee.

My employee only refused the drug or alcohol test. Is this considered a positive?

DOT views a refusal as the same as admitting guilt. A refusal to test is considered a DOT positive test and will hold the same ramifications as an employee that had a positive test result.

What are the next steps after the employee completes their DOT SAP Program?

The SAP will send a copy of the completion letter to the employer. It will instruct the employer to have a Return-to-Duty (RTD) test conducted for just drugs, just alcohol, or both drugs and alcohol on their employee. It will instruct the employer on how many follow-up (F/U) tests need to be conducted and whether they should test for drugs, alcohol, or both drugs and alcohol. Please note any DOT drug tests for RTD and F/U must be observed.

My employee has to have DOT observed collections on their RTD and F/U drug tests. What does that mean, and how is it done?

DOT requires observed tests for certain situations in drug testing. Observation simply means that there must be a same-sex observer that will go into the restroom with the donor. They will ask the donor to pull their undergarments down to their knees and turn around in a circle. The same goes for the donor’s top garments. They will ask the donor to pull up their top garments to the top of their chest and turn around in a circle. The collector will then watch the donor make their void into the cup to observe that no devices or prosthetics are being used.

When can my employee return to safety-sensitive duties and driving CDL vehicles?

Once the RTD test is conducted and the result is negative, your employee may perform their prior duties.

My employee has to have follow-up testing. How do I get those tests scheduled?

If you prefer for Tomo to manage your employee’s follow-up program, you would send a copy of the SAP’s letter to and we can take care of notifying you when the testing needs to be scheduled and completed. Otherwise, you can alert Tomo when it is time for the employee’s F/U in order to get it scheduled.

How do I ensure the testing dates for my employees follow-up tests are random and sporadic?

Like the randoms we pull, Tomo is able to use our system to generate random drug and alcohol testing dates for your employees. For more information on the randoms selection process, please see this blog post on our website.

My employee has a positive drug/alcohol test for my Drug-Free Workplace. What are my options?

We would highly recommend you to review and follow your company’s Drug and Alcohol Free Workplace (DFWP) policy that is in place for these scenarios. With a test outside of DOT, it is the company’s option how to handle the situation. It is important to consider any state laws that could be in play before acting on a positive test.     

What if my employee is insisting innocence. What are their options?

Per DOT regulations on any positive DOT drug test, an MRO must make attempts to interview the donor before they can release their findings. For DOT on a drug test when the MRO is interviewing the donor, they will provide them the option of a split test. This is when the laboratory sends off vial B to a second laboratory of the MRO’s choice to test the sample again to ensure the same result is received. This is the only way that DOT allows a retest of a positive sample before the SAP program is initiated.


The author of this blog post is Erica Bussard, and she is the Administration Specialist in the Program Administration Department. Her primary responsibility at Tomo is to handle clients’ compliance, both with Department of Transportation companies and Drug-Free Workplaces. Erica has been with Tomo 11 years and has held numerous positions in the company, including Drug and Alcohol Collector, Scheduler, Manager, and Compliance.