What employee actions are considered refusals to take a DOT drug test?

Employees in safety-sensitive positions are required to submit to DOT drug and alcohol testing outlined in the federal regulations (49, CFR Part 40).

Here are the specific actions or behaviors that the regulations deem a refusal to take a DOT drug test:

Failure to appear for the test (except a pre-employment test) within a reasonable amount of time as determined by the employer.
Failure to remain at the testing site until the test is complete. An employee who leaves the testing site during a pre-employment test is not a refusal to test…it is a refusal to take the job.
If the employee refuses to provide a urine specimen as directed it is a refusal to test.
In the case of a direct observation or monitored collection, failure to permit the observation or monitoring of the employees provision of a specimen is a failure to test.
Failure to provide a sufficient amount of urine (Shy Bladder), and it has been determined, through a medical evaluation that there was no adequate medical explanation for the insufficient amount.
Failure to undergo a medical examination or evaluation as directed by the MRO as part of the verification process, or as directed by the DER.
Fail or decline to take an additional drug test as directed by the employer or collector
Failure to cooperate with any part of the testing process (refusing to empty pockets, wash hands, confrontational behavior that disrupts the testing process).
If the MRO reports that the employee has a verified adulterated or substituted test result, it is considered an automatic refusal.