Employment Test

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.

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What It Tests

Employment testing spans multiple categories:

• 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.

• Immunity & Titers: Measles/Mumps/Rubella (MMR) IgG, Varicella IgG, Hepatitis B surface antibody (anti-HBs) to document immunity for roles like healthcare.

• TB Screening: QuantiFERON-TB Gold Plus or T-SPOT.TB IGRAs (preferred for prior BCG-vaccinated workers).

• Exposure Monitoring: Lead ± ZPP, mercury, cadmium, chromium (hexavalent) urine, arsenic urine speciation, plus role-specific baseline labs (e.g., CBC/CMP/LFTs).

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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

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When to Test

• Pre-employment / onboarding (baseline screening & documentation).

• Random, reasonable suspicion, and post-accident (safety-sensitive programs).

• Return-to-duty & follow-up schedules (DOT/non-DOT).

• Annual/periodic surveillance (healthcare TB & immunity; industrial exposure).

• Placement changes or international assignments (immunity/TB paperwork).

• After exposure incidents (needle-stick, chemical spill—follow employer protocol).

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How to Prepare

• Identification & paperwork: Bring government ID; follow COC steps for compliance collections.

• Medication/supplement disclosure: Provide Rx/OTC list; an MRO may verify legitimate prescriptions.

• Hydration: Drink normally—over-hydration can cause dilute urine.

• Oral fluid & breath alcohol: Avoid food/drink/tobacco/alcohol-containing mouthwash for the kit-specified interval.

• IGRA/Titers: No fasting needed.

• Heavy metals: Follow test-specific prep (e.g., avoid seafood before arsenic speciation).

• No tampering: Adulterants/substitution are prohibited; labs run specimen validity checks (creatinine, specific gravity, pH, oxidants).

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Interpreting Results 

• Screen vs confirm: Immunoassay positives are presumptive until GC/MS or LC-MS/MS confirmation.

• COC/MRO: Regulated programs require chain-of-custody documentation and MRO review.

• Detection windows ≠ impairment: Positives show presence above a cutoff, not on-site impairment.

• Immunity titers: Report immune vs non-immune for MMR/VZV; anti-HBs ≥10 mIU/mL is typically protective for Hep B.

• TB IGRAs: Report positive/negative/indeterminate; interpret with risk evaluation and policy.

• Exposure labs: Compare to program thresholds; follow employer protocol for repeat testing or temporary removal from exposure.

• Privacy: Results are disclosed per program policy and applicable law (e.g., MRO to employer for compliance tests).

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Related Programs / Use Cases

• Pre-employment & onboarding

• DOT & safety-sensitive roles

• Healthcare worker clearance (TB & immunity)

• Industrial/OSHA exposure monitoring

• Return-to-duty & follow-up testing

• International/academic placements (immunity documentation)

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Bundles & Panels

• Pre-Employment Base Panel – Includes 3 tests covering 9 biomarkers for foundational pre-hire screening (core health metrics applicable to employment). 

• Pre-Employment Comprehensive Panel – Contains 6 tests and 13 biomarkers expanding upon basic screening with additional indicators relevant to health compliance.

• 10-Panel Drug Test – Focuses on detecting 10 common drug classes in urine; a widely used employer-required toxicology screen. 

• Employer Wellness Screening Panel 4 – Encompasses 3 tests and 61 biomarkers covering comprehensive wellness markers beyond pre-hire basics.

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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.

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References

• SAMHSA — Workplace drug testing guidelines (screening/confirmation standards)

• U.S. DOT (49 CFR Part 40) — Drug & alcohol testing procedures for transportation employees

• CDC/ACIP — Healthcare personnel immunization & anti-HBs guidance; TB IGRA resources

• OSHA/NIOSH — Heavy-metal and exposure surveillance guidance

• ASAM — Appropriate use of drug testing in clinical addiction medicine

• 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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