MRO: MEDICAL REVIEWER OFFICER CERTIFICATION EXAM QUESTIONS
WITH VERIFIED SOLUTIONS | UPDATED VERSION | COMPREHENSIVE
REVIEW 2026/2027
Q: What federal regulation governs DOT drug and alcohol testing
programs?
ANSWER 49 CFR Part 40 (commonly referred to as "Part 40")
Question 2
Q: Who is responsible for notifying a collector that error correction
training is needed?
ANSWER The MRO, in canceling a drug test, will determine if the
collector is at fault. When the MRO reports the cancelled test to the
employer, the MRO will note the reason for the cancellation and that, if
appropriate, it was the result of collector error. The employer or service
agent designated by the employer is responsible for notifying the
collection site of the error and the retraining requirement
Question 3
Q: Must collectors, BATs, STTs, MROs, and SAPs maintain documentation
of meeting training requirements on their persons?
ANSWER No. They are responsible for maintaining documentation that
they currently meet all training requirements, but they are not required to
keep this documentation on their person. They must be able to produce
this documentation within a short, reasonable time of a request by a DOT
representative or an employer
Question 4
Q: How should the employer's decision to have a C/TPA act as
intermediary in the handling of drug test results be documented?
ANSWER This decision should be communicated from the employer to
the MRO and the C/TPA. The MRO should obtain some documentation of
the employer's decision prior to sending results through the C/TPA.
,Documentation could be in the form of a letter, an email, or record of a
telephone conversation with the employer
Question 5
Q: May the MRO's address entered on the CCF be a post-office box
number only?
ANSWER No. The address must contain at least a number and street
address. The post-office box can be included, but not in lieu of the number
and street address
Question 6
Q: May a DOT urine specimen be obtained via catheterization from a
patient who is catheterized as part of a medical procedure or who is
unconscious?
ANSWER No one is ever permitted to obtain a urine specimen for DOT
testing purposes from an unconscious individual. No one is permitted to
catheterize a conscious employee for the purpose of collecting urine for a
DOT drug test. However, if a person has been catheterized for medical
purposes (e.g., a conscious, hospitalized patient in a post-accident test
situation), it is permissible to use urine collected by this means for DOT
testing purposes
Question 7
Q: Is it acceptable for an MRO to transmit a number of reports of drug test
results per page to the employer, rather than one per page?
ANSWER If using a written report or electronic report meeting all
requirements of §40.163, rather than using Copy 2 of the CCF, the MRO
must put only one such report on each page to help prevent inadvertent
breaches of confidentiality
Question 8
Q: If the MRO uses a written report instead of a copy of the CCF to report
results to employers, how should those reports be signed?
ANSWER The MRO must sign all reports of non-negative results
(positives, refusals, tests canceled, and invalids). The MRO or an MRO's
staff member may rubber stamp and initial negative results. The rubber
stamp should identify the MRO
,Question 9
Q: What percentage of all CCFs reviewed by MRO staff must the MRO
personally review on a quarterly basis?
ANSWER At least 5 percent of all CCFs reviewed by staff on a quarterly
basis, including all results that required a corrective action. However, the
MRO need not review more than 500 negative results in any quarter
Question 10
Q: Must the MRO take action if, in reviewing 5% of CCFs each quarter, a
test with an uncorrected non-fatal flaw or error is identified?
ANSWER Yes. The MRO must correct any errors discovered, take action
as necessary to ensure compliance by staff with Part 40, and document
the corrective action
Question 11
Q: How must the MRO mark CCFs that have been covered in the quarterly
review?
ANSWER The MRO must make these CCFs easily identifiable and
retrievable for review by DOT agencies, and must attest to the quality
assurance review by initialing the CCFs reviewed
Question 12
Q: Does the laboratory transmit test results to the MRO directly, or
through a C/TPA?
ANSWER The laboratory must report laboratory results directly, and
only, to the MRO at his or her place of business. The laboratory must not
report results to or through the DER or a service agent (e.g., C/TPA)
Question 13
Q: Can a C/TPA act as an intermediary in the transmission of drug test
results from the laboratory to the MRO?
ANSWER No. A C/TPA must not act as an intermediary in the
transmission of drug test results from the laboratory to the MRO
Question 14
Q: Can a C/TPA act as an intermediary in the transmission of drug and
alcohol testing information to the employer?
, ANSWER Yes, but only if the employer chooses to have the C/TPA do so.
Each employer makes the decision about whether to receive some or all
of this information from the C/TPA acting as an intermediary
Question 15
Q: Are drug tests conducted under DOT regulations required to be
analyzed by a laboratory on the current DHHS approved list?
ANSWER Yes. A drug-testing laboratory located in the U.S. is permitted to
participate in DOT drug testing only if HHS under the National Laboratory
Certification Program (NLCP) certifies it for all testing required under
Part 40
Question 16
Q: What does the MRO report to the employer if there is a legitimate
medical explanation for a confirmed positive test result consistent with
legal drug use?
ANSWER The MRO reports the result as negative
Question 17
Q: If an employer requests, can the MRO provide the quantitative values
of the drugs verified positive, or the results of validity tests?
ANSWER No. The MRO must not provide quantitative values to the DER
or C/TPA for drug or validity test results. However, the MRO must
provide the test information to a SAP who consults with the MRO
Question 18
Q: If a SAP requests, is the MRO allowed to provide medical information
or quantitative values for drugs or validity test results?
ANSWER Yes. The MRO must provide the test information in his or her
possession to a SAP who consults with the MRO
Question 19
Q: Must the laboratory provide quantitative values for confirmed positive
drug, adulterated, and substituted test results to the MRO?
ANSWER Yes, when the MRO requests them in writing. The MRO's
request may either be a general request covering all such results or a
specific case-by-case request
WITH VERIFIED SOLUTIONS | UPDATED VERSION | COMPREHENSIVE
REVIEW 2026/2027
Q: What federal regulation governs DOT drug and alcohol testing
programs?
ANSWER 49 CFR Part 40 (commonly referred to as "Part 40")
Question 2
Q: Who is responsible for notifying a collector that error correction
training is needed?
ANSWER The MRO, in canceling a drug test, will determine if the
collector is at fault. When the MRO reports the cancelled test to the
employer, the MRO will note the reason for the cancellation and that, if
appropriate, it was the result of collector error. The employer or service
agent designated by the employer is responsible for notifying the
collection site of the error and the retraining requirement
Question 3
Q: Must collectors, BATs, STTs, MROs, and SAPs maintain documentation
of meeting training requirements on their persons?
ANSWER No. They are responsible for maintaining documentation that
they currently meet all training requirements, but they are not required to
keep this documentation on their person. They must be able to produce
this documentation within a short, reasonable time of a request by a DOT
representative or an employer
Question 4
Q: How should the employer's decision to have a C/TPA act as
intermediary in the handling of drug test results be documented?
ANSWER This decision should be communicated from the employer to
the MRO and the C/TPA. The MRO should obtain some documentation of
the employer's decision prior to sending results through the C/TPA.
,Documentation could be in the form of a letter, an email, or record of a
telephone conversation with the employer
Question 5
Q: May the MRO's address entered on the CCF be a post-office box
number only?
ANSWER No. The address must contain at least a number and street
address. The post-office box can be included, but not in lieu of the number
and street address
Question 6
Q: May a DOT urine specimen be obtained via catheterization from a
patient who is catheterized as part of a medical procedure or who is
unconscious?
ANSWER No one is ever permitted to obtain a urine specimen for DOT
testing purposes from an unconscious individual. No one is permitted to
catheterize a conscious employee for the purpose of collecting urine for a
DOT drug test. However, if a person has been catheterized for medical
purposes (e.g., a conscious, hospitalized patient in a post-accident test
situation), it is permissible to use urine collected by this means for DOT
testing purposes
Question 7
Q: Is it acceptable for an MRO to transmit a number of reports of drug test
results per page to the employer, rather than one per page?
ANSWER If using a written report or electronic report meeting all
requirements of §40.163, rather than using Copy 2 of the CCF, the MRO
must put only one such report on each page to help prevent inadvertent
breaches of confidentiality
Question 8
Q: If the MRO uses a written report instead of a copy of the CCF to report
results to employers, how should those reports be signed?
ANSWER The MRO must sign all reports of non-negative results
(positives, refusals, tests canceled, and invalids). The MRO or an MRO's
staff member may rubber stamp and initial negative results. The rubber
stamp should identify the MRO
,Question 9
Q: What percentage of all CCFs reviewed by MRO staff must the MRO
personally review on a quarterly basis?
ANSWER At least 5 percent of all CCFs reviewed by staff on a quarterly
basis, including all results that required a corrective action. However, the
MRO need not review more than 500 negative results in any quarter
Question 10
Q: Must the MRO take action if, in reviewing 5% of CCFs each quarter, a
test with an uncorrected non-fatal flaw or error is identified?
ANSWER Yes. The MRO must correct any errors discovered, take action
as necessary to ensure compliance by staff with Part 40, and document
the corrective action
Question 11
Q: How must the MRO mark CCFs that have been covered in the quarterly
review?
ANSWER The MRO must make these CCFs easily identifiable and
retrievable for review by DOT agencies, and must attest to the quality
assurance review by initialing the CCFs reviewed
Question 12
Q: Does the laboratory transmit test results to the MRO directly, or
through a C/TPA?
ANSWER The laboratory must report laboratory results directly, and
only, to the MRO at his or her place of business. The laboratory must not
report results to or through the DER or a service agent (e.g., C/TPA)
Question 13
Q: Can a C/TPA act as an intermediary in the transmission of drug test
results from the laboratory to the MRO?
ANSWER No. A C/TPA must not act as an intermediary in the
transmission of drug test results from the laboratory to the MRO
Question 14
Q: Can a C/TPA act as an intermediary in the transmission of drug and
alcohol testing information to the employer?
, ANSWER Yes, but only if the employer chooses to have the C/TPA do so.
Each employer makes the decision about whether to receive some or all
of this information from the C/TPA acting as an intermediary
Question 15
Q: Are drug tests conducted under DOT regulations required to be
analyzed by a laboratory on the current DHHS approved list?
ANSWER Yes. A drug-testing laboratory located in the U.S. is permitted to
participate in DOT drug testing only if HHS under the National Laboratory
Certification Program (NLCP) certifies it for all testing required under
Part 40
Question 16
Q: What does the MRO report to the employer if there is a legitimate
medical explanation for a confirmed positive test result consistent with
legal drug use?
ANSWER The MRO reports the result as negative
Question 17
Q: If an employer requests, can the MRO provide the quantitative values
of the drugs verified positive, or the results of validity tests?
ANSWER No. The MRO must not provide quantitative values to the DER
or C/TPA for drug or validity test results. However, the MRO must
provide the test information to a SAP who consults with the MRO
Question 18
Q: If a SAP requests, is the MRO allowed to provide medical information
or quantitative values for drugs or validity test results?
ANSWER Yes. The MRO must provide the test information in his or her
possession to a SAP who consults with the MRO
Question 19
Q: Must the laboratory provide quantitative values for confirmed positive
drug, adulterated, and substituted test results to the MRO?
ANSWER Yes, when the MRO requests them in writing. The MRO's
request may either be a general request covering all such results or a
specific case-by-case request
