What Happens When an Employee Cannot Provide Enough Urine for a DOT Test?

When an employee does not provide at least 45 mL of urine in a single void, 49 CFR 40.193 calls for the collector to give another opportunity, which is often called the shy bladder procedure.

Under the rule, the collector discards the insufficient specimen, unless it was out of temperature range or showed signs of tampering, and urges the employee to drink up to 40 ounces of fluid spread through a period of up to three hours. The rule states that declining to drink is not a refusal to test. Under 49 CFR 40.65, urine from separate voids may never be combined.

If the employee has not provided a sufficient specimen within three hours of the first unsuccessful attempt, the collector stops the collection and notifies the Designated Employer Representative (DER). The DER, after consulting the Medical Review Officer (MRO), directs the employee to get an evaluation from a licensed physician acceptable to the MRO within five days. The rule states that unsupported claims of situational anxiety or dehydration do not count as a medical condition.

Under 40.193(d), the physician makes a recommendation to the MRO, and the MRO who accepts it marks the test on the CCF as cancelled or as a refusal to test. MROs are one of the provider types listed in the MyDrugTesting.com directory.