Author: Alex Maio

DOT physicals ensure the health and safety of commercial vehicle (CMV) drivers and the public. These physicals often involve the disclosure and handling of an employee’s private medical information as well as drug and alcohol testing results, which raises questions about Health Insurance Portability and Accountability Act (HIPAA) laws.

However, the rules around HIPAA and DOT physicals are not clear-cut. Although DOT physicals are confidential, DOT law allows any employer or service agent in the DOT drug and alcohol testing program to disclose testing information without the employee’s authorization.

This blog explains medical privacy in the context of HIPAA and DOT physicals, potential overlaps and conflicts, and when drug and alcohol testing information can be disclosed.

Understanding HIPAA

HIPAA is a federal law that establishes standards to protect sensitive patient health information from being disclosed without the patient’s knowledge or consent.

The U.S. Department of Health and Human Services (HHS) issued a HIPAA Privacy Rule to implement HIPAA requirements. The rule’s standards address the use and disclosure of protected health information (PHI) by covered entities. HIPAA also outlines standards for an individual’s right to understand and control how their health information is used.

The Privacy Rule aims to ensure the proper safeguarding of individuals’ health information while facilitating the necessary flow of such information to deliver and enhance high-quality healthcare. Additionally, it seeks to safeguard public health and well-being.

The Essence of DOT Physicals

A DOT physical exam is required for people who drive commercial motor vehicles (CMVs). To ensure the safety of the public, the Federal Motor Carrier Safety Administration (FMCSA) rules mandate that drivers are physically, mentally, and emotionally fit to perform this demanding role.

A driver must participate in a physical – which includes a drug and alcohol test – to maintain a valid commercial driver’s license (CDL). The exam is valid for 24 months.

Key Requirements for a DOT Physical

A medical examiner performs DOT physicals. During a DOT physical, an employee or job candidate will undergo a series of medical checks and tests including the following:

• Vision
• Hearing, blood pressure, and heart rate
• Urinalysis
• Physical examination (eyes, skin, general appearance, lung and chest function, neurological indicators, limb function, and more).
• Drug and alcohol test
• A sleep apnea test may also be ordered.

The medical examiner will also inquire about family history, medications, tobacco use, and current health problems.

HIPAA and DOT: Where They Intersect

HIPAA privacy laws protect the confidentiality of patient medical records and PHI.

In most cases, an employer or service agent participating in the DOT drug and alcohol testing process is prohibited from releasing individual test results or medical information to third parties without the employee’s written consent.

However, there are exceptions. Medical professionals and facilities involved in the testing process, such as laboratories and Medical Review Officers (MROs), do not need an employee’s written authorization to disclose drug testing information. That’s because, technically, anyone undergoing a drug and alcohol test is not a patient, but a donor. The test is also not considered a medical examination or diagnosis and is not concerned with the preventative, therapeutic, rehabilitative, or mental health of a patient. A DOT drug test is a forensic screening test used to determine if an individual meets DOT safety requirements for operating a CMV.

This conflict often creates confusion among employers and employees who wonder: “Are DOT physicals confidential?” and “Are drug test results confidential under HIPAA?”

Disclosing Drug and Alcohol Testing Information

DOT drug and alcohol testing information can be disclosed without violating HIPAA rules under the following conditions:

• Where disclosing the information is required by the DOT’s rule 49 CFR Part 40 which describes procedures for conducting workplace drug and alcohol testing for the federally regulated transportation industry.
• Even if drug and alcohol testing information is considered protected under HIPAA rules, employers are not required to obtain written consent from employees if the DOT requires disclosure of this information under the 49 CFR Part 40 rule. Among other things, this means that:
  • Screening test technicians and laboratories can report results to MROs without the written consent of the employee.
  • MROs can also report results to employers, discuss results with prescribing physicians, and confer with Substance Abuse Professionals (SAPs) and evaluating physicians, without the employee’s consent.
• Employers and service agents can also release testing information to requesting federal, state, and local agencies that have regulatory authority over them or their employees.

Furthermore, during claims litigation following a CMV accident, a claimant can request DOT physical information and medical examiner certificates of the driver involved.

Practical Implications

Drivers who undergo drug and alcohol testing as part of a DOT physical must understand the subtle interpretations of the law. In certain instances, DOT regulatory requirements that govern the safety of drivers and the public take precedence over HIPAA medical privacy and PHI confidentiality rules.

As such, CMV drivers must understand that any testing information can be shared with a prospective or current employer, MROs, and regulatory bodies. This information can be a deciding factor in whether a driver can obtain or retain a CMV license, or even be removed from duty.

Drug and alcohol testing history may also follow an individual to a new employer – if the individual agrees to the release of that information.

Addressing Common Questions About HIPAA and DOT Physicals

Balancing HIPAA and DOT Physicals

DOT physicals are an essential part of occupational health and safety in industries regulated by the DOT. However, employers and employees must understand the applicability of medical privacy laws, like HIPAA, and when and how DOT regulations override those laws.

Acuity can help employers navigate the complexities of DOT physicals while ensuring compliance with HIPAA rules.

We offer a wide range of workplace DOT physical exam services, including pre-employment, random, reasonable suspicion, DOT drug and alcohol tests, return-to-duty, and follow-up tests.

These services are backed by advanced technology and a widespread provider network to give employers 24/7 access to scheduling, testing status notifications, case management reporting, and more.

Learn more about Acuity’s comprehensive portfolio of Occupational Health Services.

Regulated and non-regulated drug testing is a common practice used by employers to screen for substance abuse. Drug testing is an important preventative measure that helps employers maintain a drug-free workplace and minimize the risk of injury or accident – especially if an employee operates heavy equipment or machinery.

Regulated drug testing is a test required by the U.S. Department of Transportation (DOT) for workers in regulated industries, such as commercial vehicle drivers. Non-regulated drug screening is a test given to workers in industries not regulated by the DOT, often as a condition of employment.

In this blog, we answer the question “what is a non-regulated drug screen?” and explain what these tests involve, how employers can implement a non-DOT drug testing program, and challenges and considerations for workplace drug screening.

Understanding Non-Regulated Drug Screens

Let’s look at how non-regulated drug testing differs from DOT-drug testing programs.

Definition and Overview

A non-DOT drug test is implemented by employers as part of a workplace drug screening program. Unlike a regulated drug screen, employers have the freedom to choose the mode of testing – urine, saliva, or hair specimens – and select the drugs they want to test for.

Regulated drug screening, or DOT drug tests, are defined by government regulation, specifically DOT rule, 49 CFT Part 40, which describes procedures for conducting workplace drug and alcohol testing for the federally regulated transportation industry. The ruling applies to employees in the transportation industry who are in safety-sensitive jobs, such as commercial motor vehicle (CMV) drivers.

Why Non-Regulated Drug Screens are Important

Non-regulated drug screens are an essential part of ensuring workplace safety and efficiency. By filtering out substance abuse, drug testing can reduce risks associated with workplace incidents and potential damages and provide cost savings. It also protects employees and is a deterrent against drug use in the workplace.

In addition, drug screening takes the guesswork out of hiring and promotes a culture of health and wellness.

Types of Non-Regulated Drug Tests

Non-regulated drug screening is performed at various times during employment. Different types of tests include pre-employment drug tests, random testing, post-accident testing, and return-to-duty tests.

There are a variety of testing methods that employers can use to perform a non-regulated drug screen.

Various Testing Methods

Several methods can be used for non-regulated drug testing, including urine, blood, hair, and saliva tests. Let’s explore these four primary forms of drug tests along with their respective accuracy and detection periods:

• Urine tests: This method is the most used for drug screening because it is convenient, painless, and cost-effective. Results are typically available within a few days, sometimes even on the same day. However, urine tests have a limited detection window, usually ranging from five to ten days after the sample collection.
• Blood tests: Blood tests offer high accuracy and can swiftly detect illicit substances within minutes or hours. Nevertheless, they tend to be expensive and inconvenient.
• Hair follicle tests: Considered more reliable than other drug testing forms, such as urine and blood tests, hair follicle drug screening takes advantage of the fact that drugs and their metabolites persist in the hair as it grows. This method can identify the use of various substances like cocaine, amphetamines, opioids, methamphetamines, PCP, and others. Detection times vary, with scalp hair having a window of three months and body hair extending up to a year.
• Saliva tests: An effective alternative to urine testing, saliva tests serve as a useful backup if an individual cannot provide an adequate urine sample. They can detect drugs within a short timeframe, typically within 48 hours.

Common Drugs Test in Non-Regulated Screens

Some of the drugs that non-regulated drug tests screen for include:

• Opiates, amphetamines, and narcotics
• Phencyclidine (PCP)
• Barbiturates and benzodiazepines
• Marijuana
• Antidepressants
• Stimulants

The most common form of non-DOT drug screen is the five-panel test that detects cocaine, marijuana, amphetamines, opioids, and PCP.

Implementing Non-Regulated Drug Screens in the Workplace

Setting up a workplace drug screening program involves careful planning and implementation to ensure compliance with regulations, fairness, and accuracy.

Setting Up a Drug Screening Program

Here’s a step-by-step guide to help you establish a workplace drug screening program:

1. Observe legal compliance: Research and understand local, state, and federal laws regarding workplace drug testing. Ensure that your program aligns with legal requirements and regulations.
2. Define program objectives: Clearly define the objectives of your drug screening program. Determine whether you are implementing pre-employment testing, random testing, post-accident testing, or a combination.
3. Develop a written policy: Create a comprehensive written drug-free workplace policy. Clearly communicate the purpose of the program, the types of tests used, consequences for positive results, and employees’ rights and responsibilities.
4. Provide employee education: Educate employees about the drug-free workplace policy. Make sure they understand the reasons for testing, the procedures involved, and the potential consequences of a positive result.
5. Select a testing method: Choose the appropriate testing methods for your program. Common methods include urine testing, blood testing, hair follicle testing, and saliva testing. Consider the nature of your workplace and the specific drugs you want to detect.
6. Choose a testing vendor: Select a reputable, certified drug testing vendor. Ensure they comply with industry standards, maintain data privacy, and provide accurate and timely results.
7. Establish testing procedures: Clearly outline the procedures for collecting and handling samples, maintaining confidentiality, and ensuring the integrity of the testing process. Train designated staff members on proper procedures.
8. Employ a randomization process: If implementing random testing, establish a fair and unbiased process for selecting employees. This helps ensure that all eligible employees have an equal chance of being selected.
9. Include a Medical Review Officer: Consider hiring a Medical Review Officer (MRO) or work with a testing partner who has a network of MROs to help interpret and review test results. An MRO ensures that there are no false positives and provides a confidential channel for employees to discuss prescription medications.
10. Communicate results: Develop a clear process for communicating test results to employees. Respect confidentiality and provide a mechanism for employees to dispute or verify results if needed.

Benefits of Drug Screening for Employers

Drug addiction is one of the most prevalent health issues in the United States. In addition to impacting an individual’s well-being, substance use disorders (SUDs) can have profound impacts in the workplace. According to data from Recovery Centers of America, 70% of people who use illegal drugs are employed either full or part-time and 75% of them remain untreated.

In addition to health and safety concerns, SUDs inflict an annual cost of $81 billion on employers, covering healthcare expenses, disability and worker’s compensation, recruitment costs, and more.

Moreover, it is claimed that employees who test positive for drug and alcohol use are 10 to 60 percent less productive than persons who test negative.

Given these potential impacts, many employers are opting to screen job candidates and employees for drug use. Non-regulated drug screening enhances workplace safety, minimizes absenteeism, saves money, and improves employee performance and productivity.

Challenges and Considerations

Despite the benefits of non-regulated drug testing in the workplace, screening employees for drug use raises ethical, privacy, and accuracy concerns.

Ethical and Privacy Concerns

Workplace drug screening ethical and privacy concerns include the sharing of drug test data without the employee’s consent.

Be sure to research and understand local, state, and federal laws regarding workplace drug testing. Ensure that your program aligns with legal requirements and regulations, particularly as it pertains to data privacy.

To enjoy the benefits of drug testing while respecting the rights of employees, consider partnering with a non-regulated drug testing provider. Select one who understands federal, state, and local laws and requirements, always ensures the security and confidentiality of employee data, and has a network of professional, licensed MROs who can act as impartial gatekeepers and advocate for the accuracy and integrity of the drug testing process.

Remember, transparency, fairness, and consistency are essential elements of a successful workplace drug screening program. Regularly communicate with employees, address their concerns, and emphasize the program’s commitment to a safe and healthy work environment.

Accuracy and Reliability of Results

Non-regulated drug screens are very accurate. And, because a health professional collects the sample, the results cannot be tampered with. However, there may be challenges such as false positives and false negatives.

If an employee suspects a false positive result, they may request a second test of the same specimen sample. Understand that false positives can occur and be willing to accommodate the request.

If, as an employer, you encounter a false negative but have suspicions, confirmatory testing should be requested to determine if it is a false or true negative.

Conclusion: The Role of Non-Regulated Drug Screens in Modern Workplaces

Non-regulated drug screening is a simple way to ensure a safe and productive workforce. These tests can be applied to many use cases, including pre-employment screening, random testing, return-to-work testing, and post-accident testing.

If you are looking to begin a non-regulated drug screening program in your organization, look no further than the experts at Acuity International. We offer in-depth drug test screening for all organizations and industries, including companies that must comply with Department of Transportation drug screening regulations.

Contact Acuity today to learn more.

A pre-employment blood test is an essential screening practice that ensures the safety and productivity of employees and the public. A blood test can be performed to determine whether prospective new hires have consumed alcohol or drugs, both prescription and illicit.

In this blog, we answer the question “What is a pre-employment drug test for?” We also explore how these blood tests are performed, common substances tested for, the legality of drug testing, and more.

Understanding the Purpose of Pre-Employment Blood Tests

Implementing a pre-employment blood testing program can help employers maintain a drug and alcohol-free workplace while ensuring adherence to government regulations, including those set forth by U.S. Department of Transportation (DOT) and U.S. Department of Labor (DOL) laws.

By filtering out drug and alcohol use, pre-employment blood testing minimizes the risks associated with workplace incidents but also serves as a deterrent for substance abuse. This proactive approach can lead to a reduction in potential liabilities, translating into substantial cost savings.

In addition, pre-employment blood testing takes the guesswork out of hiring, reduces absenteeism, increases worker productivity and performance, and promotes a culture of health and wellness.

The Role of Drug Testing in Employment

Drug addiction is among the most common health conditions in America. In addition to affecting a person’s health, relationships, and finances, the impact of substance use disorders (SUDs) also extends to the workplace. According to Recovery Centers of America, 70% of people who use illegal drugs are employed either full or part-time, and 75% of those people don’t receive treatment.

In addition to productivity losses, SUDs are costly for employers. Recovered.org (formerly The National Council on Alcoholism and Drug Dependence) estimates that addiction costs employers $81 billion each year in healthcare expenses, disability and worker’s compensation, recruitment expenses, and more.

For these reasons, pre-employment drug screening is an important component of the applicant hiring process. In fact, many employers, such as those regulated by the DOT as well as safety-sensitive industries, including hospitals, first responders, and construction, test candidates for drug use before extending an offer.

Common Substances Tested in Pre-Employment Drug Tests

Some of the drugs that pre-employment drug tests detect include:

• Opiates, amphetamines, and narcotics: Drugs like cocaine can be highly addictive when used regularly and in large quantities.
• Phencyclidine (PCP): A street drug, also known as angel dust, PCP is a hallucinogen that can distort vision and hearing, and create feelings of detachment.
• Barbiturates and benzodiazepines: Including medications used to treat anxiety, depression, insomnia, etc.
• Marijuana
• Antidepressants: Side effects can include nausea, dizziness, and fatigue.
• Stimulants: Often prescribed for ADHD and other disorders, these substances can lead to increased heart rate, high blood pressure, and other serious side effects.

The most common pre-employment drug test is the five-panel test that detects cocaine, marijuana, amphetamines, opioids, and PCP.

Different Types of Drug Testing Specimens

There are a variety of methods used for drug testing, including urine, blood, hair, and saliva tests. Let’s look at these four primary forms of drug tests and the accuracy and detection period of each test:

• Urine tests: A urine drug screen is the most used drug test method. They are painless, easy, and cost-effective. Typically, the results become available within a few days, and in some instances, they can be obtained on the same day. However, urine testing has a small window for detection. Most substances can only be detected for five to ten days after the sample was collected.
• Blood tests: Blood tests are very accurate and can detect illicit substances in a matter of minutes or hours. However, they are costly and inconvenient.
• Hair follicle tests: Hair follicle drug screening is far more reliable than any other form of drug testing, including urine and blood sample analysis. That’s because drugs and drug metabolites remain in the hair as it grows. These tests can detect the use of cocaine, amphetamines, opioids, methamphetamines, PCP, and other drugs. Detection times vary from three months for scalp hair to up to a year for body hair.
• Saliva tests: A saliva test is an effective alternative to urine testing and is a useful backup if an individual fails to provide sufficient urine. Saliva tests detect drugs within a short time frame, typically within 48 hours. The DOT recently authorized the use of oral fluid testing as part of employer DOT drug testing programs. The choice of whether to conduct an oral fluid or a urine test is up to the employer.

The Legal Aspects of Pre-Employment Drug Testing

Most states permit employers to test job applicants for drugs or alcohol, although the legality of testing varies by state. Furthermore, the specific guidelines and protocols for these tests are typically established by the employer in compliance with state employment regulations.

Note: Industries regulated by the DOL and DOT are required by law to test job candidates for drugs and alcohol.

Best Practices for Pre-Employment Drug Testing

The following best practices can help employers administer legal and fair pre-employment blood tests:

• Job applicants must be informed about the inclusion of drug or alcohol testing in the interview process.

• Tests must be carried out by a state-certified lab and reviewed by a Medical Review Officer (MRO).
• Equal opportunity laws and the Americans with Disabilities Act (ADA) require that all applicants for the same position must undergo the same type of drug test.
• Employers must treat employee health information as confidential in accordance with HIPAA and the ADA. All applicant information, including personally identifiable information (PII), protected health information (PHI), and test results should remain confidential. Drug and alcohol test results should only be shared on a need-to-know basis with the relevant department.

The Importance of Partnering with Occupational Health Providers

While many urgent care providers offer pre-employment drug testing services, they may not possess the expertise required to conduct a comprehensive range of tests, such as urine, blood, hair follicle, saliva, and others to ensure compliance with government regulations. Moreover, these providers lack the capability and scale to offer the essential support and assistance that employers require. This includes aiding in developing a drug testing program, real-time test tracking and reporting, data management and secure transmission, and physician medical review services, among others.

By working with a specialized health provider for drug and alcohol testing (DAT), employers can implement an accurate, compliant, flexible, and scalable program that meets their unique needs and risks. These services should be backed by robust case management, tracking, and secure HIPAA-compliant reporting services.

Occupational health providers also offer comprehensive support, including subject matter expertise, guidance, program management, and training on implementing pre-employment drug testing programs.

For additional flexibility, employers should seek out a provider who can perform testing onsite or via mobile occupational health clinics.

Additional Pre-Employment Tests and Screenings

Additional pre-employment tests and screenings may be required for specific jobs and industries, especially if the position is physically demanding. In such cases, it is advisable to conduct pre-employment physical exams. These tests evaluate several factors, including:

• Physical ability (including the ability to perform certain functions required for the position, such as lifting or aerobic activity)
• Vital functions (heart, vision, hearing, etc.)
• Mental health, emotional, psychological, and cognitive function
• Strength, stamina, and physical endurance

Other tests include respirator fit exams and COVID testing.

Preparing for a Pre-Employment Blood Test: What to Expect

To prepare for a pre-employment blood test, job applicants should follow these steps:

• Bring a photo ID to the collection site.
• Complete all relevant paperwork accurately (paying special attention to reporting prescriptions and prescription drug use, including dosage).
• For urine tests, drink plenty of water beforehand. The test requires 45 milliliters of urine. If an individual can’t produce sufficient urine the collector will provide a reasonable amount of fluids to drink during a period of time up to three hours.

Once collected, the sample will be sent to a state-certified lab for testing and review by an MRO.

Pre-Employment Blood Tests: An Essential Screening in the Modern Workplace

Prioritizing workplace safety is paramount for any company, and one effective measure to mitigate risks linked to drug and alcohol misuse is the implementation of pre-employment drug tests. By clearly stating on a job application that a job offer could depend on the outcome of a drug test, an employer can discourage individuals with substance abuse issues from applying in the first place.

This is especially crucial for roles in safety-sensitive environments. Pre-employment drug testing plays a critical role in ensuring compliance with DOT and DOL regulations, minimizing workplace accidents and injuries, and reducing the frequency and cost of expensive workers’ compensation claims related to drug or alcohol use.

If you are looking to start or optimize your pre-employment blood testing program, contact us to learn more about how Acuity can help. We combine our pre-employment drug and alcohol testing services with advanced technology and a widespread provider network to give organizations 24/7 access to scheduling, exam status notifications, case management reporting, and more.

We also provide comprehensive pre-employment physical exam services so you can be assured that a job candidate does not have physical limitations or an existing medical condition that would prevent them from performing a job.

Learn more about Acuity’s comprehensive portfolio of Occupational Health Services.

When is return to duty testing required? A RTD test is part of the return-to-work process for employees in safety-sensitive industries who have tested positive for drug and/or alcohol use or have violated workplace drug and alcohol policy.

In this blog, we explain the RTD process, who must take the test, and the importance of treatment and follow-up testing.

Understanding the Return-to-Duty Process

Statistics show that more than 70% of Americans dealing with drug or alcohol addiction are employed. These employees pose significant health and safety risks to their employers, co-workers, and the public. If they violate workplace drug and alcohol policy or work in a safety-sensitive job, they may find themselves removed from duty.

Fortunately, RTD testing gives employees a second chance.

Incidents Leading to RTD Testing

There are three circumstances that can trigger an RTD test in safety-sensitive industries.

1. Positive drug/alcohol test: U.S. Department of Transportation (DOT) regulation requires that any employee in a safety-sensitive position who tests positive for drug or alcohol on a random drug test or based or a reasonable suspicion test must be removed from duty. The individual must then complete a drug and alcohol treatment program under the supervision of a Substance Abuse Professional (SAP). A negative RTD test result must be recorded before they can return to work.
2. Violation of a drug or alcohol rule or policy: Violations may include possession of drugs or alcohol at work or transporting drugs or alcohol while operating a commercial vehicle. In these circumstances, the employee must be removed from duty, complete a drug and alcohol treatment program, and undergo an RTD test.
3. Refusal: If an employee refuses to take a random drug test or reasonable suspicion test, they may be removed from duty. To return to duty, they must complete a drug and alcohol treatment program and undergo an RTD drug test.

Steps in the RTD Process

The RTD process encompasses the following steps:

Step 1: Removal from duty

An employee must be immediately removed from duty following a workplace drug or alcohol violation or positive drug/alcohol test as confirmed by a Medical Review Officer (MRO). The MRO must also report the violation to the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse.

Step 2: SAP evaluation

If the employee wishes to return to work, they must submit to an evaluation by a Substance Abuse Professional (SAP). The employer must provide the employee with a list of DOT-approved SAPs.

Following the face-to-face assessment of the employee, the SAP will establish a drug and alcohol treatment program.

Step 3: Completion of treatment

Once the treatment is complete, the assigned SAP will review the employee’s progress and determine if they are ready to take an RTD test and return to work upon a negative result. The SAP may also recommend continued counseling as part of any follow-up care.

If the employee fails to complete treatment or requires additional evaluation or treatment, the SAP will not clear them for return to work.

Step 4: Reporting

The SAP will communicate their findings to the employer, providing details on the employee’s progress in treatment and the number of follow-up drug tests required.

Step 5: RTD test

After examining the report, the employer is required to arrange an RTD drug test for the employee. The test should be performed under direct supervision to ensure an untampered result. To pass the RTD test, the employee must exhibit the following results:

• Alcohol concentration of less than 0.02; and/or
• Controlled substances with a result indicating a verified negative result for drug use.

Employers must notify the FMCSA Clearinghouse of successful treatment completion and negative test results. Follow-up test results must also be reported to the FMCSA.

Role of the Substance Abuse Professional

A Substance Abuse Professional or SAP is a medical professional who evaluates employees who have violated a DOT drug and alcohol program regulation.

To become an SAP, the individual must pass the Certified Substance Abuse Program Administrator (C-SAPA) exam. Once certified, an SAP can make recommendations concerning employee treatment, follow-up testing, and aftercare.

Importantly, an SAP doesn’t advocate for the employee or the employer. Their main task is to protect the public. After all, the decisions they make determine whether to place an employee behind the wheel of a truck, in an aircraft cockpit, or at the throttle of a train.

As part of their duties, SAPs must be knowledgeable of DOT procedures for transportation workplace drug and alcohol testing programs (49 CFR Part 40), including substance abuse return to duty processes, employee confidentiality laws, and more.

Finding a Qualified SAP

As part of the RTD process, employers are required to provide employees with a list of SAPs qualified in accordance with DOT Rule 49 CFR Part 40 Section 40.281.

If the employer does not provide a list, employees can search the internet using terms such as “DOT qualified SAP.”

Post-Treatment and Return-to-Work

Following treatment and return-to-work the employee must submit to a series of follow-up RTD tests as recommended by the SAP.

Types of Drug and Alcohol Tests Post-Treatment

In addition to the initial RTD test, the SAP will establish the number of tests required after treatment and return to work based on regulatory requirements or company policy. DOT law requires a minimum of six unannounced, random tests during the first 12 months following resumption of work.

These tests must be conducted under direct observation. All results must be reported to the FMCSA Clearinghouse.

Common Questions About RTD Testing

Unraveling the Mystery: Why “When is Return to Duty Testing Required” Matters

RTD testing is vital to ensuring a safe and compliant workplace. When is RTD testing required? Employees in safety-sensitive and regulated industries must undergo RTD testing following a positive drug/alcohol test, violation of a workplace drug or alcohol rule or policy, or refusal to submit to a random drug/alcohol test.

At Acuity, we offer a wide range of workplace drug and alcohol testing services, both for regulated and non-regulated industries, including pre-employment, random, reasonable suspicion, DOT drug and alcohol tests, RTD, and follow-up tests.

These services are backed by advanced technology and a widespread provider network to give employers 24/7 access to scheduling, testing status notifications, case management reporting, and more.

Learn more about Acuity’s comprehensive portfolio of Occupational Health Services.

A comprehensive drug test is a screening method designed to detect a variety of substances, including prescription and over-the-counter medications and illegal drugs. A comprehensive drug test can identify hundreds of substances, including those that go undetected during routine testing. These tests play a crucial role in employment screening and are useful for identifying and treating addiction.

In this blog, we look at what comprehensive drug testing entails, the science behind it, how to interpret test results, and more.

Understanding Comprehensive Drug Testing

A comprehensive drug test is designed to look for hundreds of prescription and non-prescription medications, as well as illicit drugs and even alcohol. These highly sensitive and specific tests can easily identify substances in blood and urine that other tests fail to detect, making them a powerful tool for workplace and overall health screening.

Why is it Called “Comprehensive”?

Comprehensive drug panels detect many more substances than other targeted drug tests, which may only discover a certain subset of drugs or medications. Thus, these tests are considered “comprehensive” because they screen for a wide range of substances.

Common Drugs Detected

Some of the drugs that comprehensive drug screens detect include:

• Opiates, amphetamines, and narcotics—all of which can be highly addictive when used regularly and in large quantities.
• Barbiturates and benzodiazepines, including medications used to treat anxiety, insomnia, etc.
• Cannabinoids—active ingredients in marijuana.
• Antidepressants, which can cause significant side effects, including nausea, dizziness, and fatigue.
• Stimulants, which are often prescribed for ADHD and other disorders but can lead to increased heart rate, high blood pressure, and other serious side effects.

There are many reasons employers may wish to consider implementing comprehensive drug testing for their workforces. Comprehensive drug tests can reveal whether an employee or prospective employee is using substances that could impact their ability to do their jobs effectively, resulting in greater worker productivity. They can also be an effective tool for maintaining a safe and happier working environment for everyone.

Comprehensive drug screening can also help organizations reduce liability and save money. The National Council on Alcohol and Drug Dependence estimates that substance use disorders cost companies $81 billion annually through lost productivity and absenteeism, turnover and recruitment costs, workplace accidents, healthcare expenses, and more. Testing can identify employees who might be engaging in substance abuse and mitigate these costs.

Most importantly, comprehensive drug tests can lead to employees getting the treatment they need to help them become healthier. Thus, comprehensive drug testing does not just improve a company’s bottom line; it can improve employees’ lives.

Types of Comprehensive Drug Tests

There are several types of comprehensive drug tests, each with its own unique processes, benefits, and limitations. Here, we’ll explore the advantages and disadvantages of comprehensive urine and blood tests, as well as a few other lesser-known testing methods.

Urine Drug Screen

A urine drug screen is the most commonly used comprehensive drug test method. They are painless, easy, and cost-effective.

With a urine test, a person simply urinates into a plastic container and provides the sample to a technician or doctor. The person collecting the sample then measures the temperature of the sample to ensure it is suitable for testing. If it is, the sample is sealed in a plastic bag and sent to a laboratory for a urinalysis. Results are usually available within a few days or, in some cases, on the same day.

A physician or medical review officer will evaluate the test results and explain their findings to the test subject. In the case of a positive test, the subject may be asked to re-test to ensure that the results are accurate.

Blood Tests and Other Methods

Urine tests are not the only type of comprehensive drug screen. Other methods include:

• Blood tests. These very precise tests are particularly useful in detecting high levels of alcohol.
• Hair follicle tests can detect the use of cocaine, amphetamines, opioids, methamphetamines, phencyclidine (PCP), and other drugs. Hair follicle tests can vary based on the characteristics of each person’s hair. Scalp follicles have a detection time of about three months, while body hair can have a detection time of up to a year.
• Sweat tests use perspiration to determine levels of illegal substances in a person. With sweat testing, an absorbent pad is placed on a person’s skin. It is used to monitor how much of and what kind of substance the person consumes while wearing the pad. Detection windows range from hours to weeks.
• Oral fluid tests, which test for controlled substances in a donor’s saliva. Oral fluid tests were recently approved by the U.S. Department of Transportation.

The Science Behind Drug Testing

Urine drug screens are usually very accurate, but false positives are possible. In general, immunoassay (IA) urine tests are more prone to false positive results than gas chromatography-mass spectrometry (GC-MS) tests. In fact, GC-MS tests are often used to confirm the results of IA tests. GC-MS tests can also detect more substances, making them the most comprehensive of all urine drug screens.

GC-MS combines gas chromatography and mass spectrometry to identify various substances in a test sample. Gas chromatography separates and analyzes compounds in a mixture; mass spectrometry measures the mass-to-charge ratio of ions. When put together, the two analytical processes can positively identify even very small amounts of substances in a person’s system. This makes the GC-MS test the “gold standard” when it comes to comprehensive drug testing.

However, GC-MS testing is more expensive than an IA test, and the results take longer to retrieve. Therefore, IA tests are more commonly used.

An IA test measures the presence of macromolecules through the use of an antibody or antigen. These antibodies can detect the presence of drugs and other substances. IA testing is usually considered the frontline when it comes to comprehensive drug testing because of its ease, cost-effectiveness, and ability to deliver results quickly.

Interpreting Drug Test Results

Interpreting the results of a comprehensive drug test can sometimes be challenging. According to the Mayo Clinic, people who misuse drugs are adept at finding ways to mask their drug use, via methods such as adulteration, urine substitution, and urine dilution. It’s important that physicians and medical review officers know what to look for, including:

• The color of a urine sample. A normal urine sample is pale yellow or clear, depending on concentration.
• A pH less than 3 or greater than 11, which could indicate adulteration or dilution of the sample.

Assuming the sample has not been tampered with, the actual interpretation of test results is straightforward. That’s because drug screen results are reported as either positive or negative. Some tests will state the concentration of the drug or metabolite contained in the sample.

Factors Affecting Test Results

There are many factors that can affect the results of a comprehensive drug screen. Some of the most prominent ones include:

• Metabolism. High metabolism helps a person’s body process and remove the residue of drugs more quickly. Therefore, a test performed on a person with a high metabolism has a higher chance of returning a false-negative result.
• Drug half-life. Half-life is the amount of time a drug stays in a person’s system. Half-life is different depending on the drug. Some drugs have a longer half-life than others, which makes them more likely to show up in a drug test (depending on when the test is taken). For example, the half-life of Xanax is four days, whereas the half-life of Fentanyl is one to three days.
• Frequency of drug use. A substance that is used more frequently is more likely to be discovered on a comprehensive drug test, simply because there is a higher likelihood that the drug may be in the subject’s system at the time of testing.
• Dosage. The higher a drug’s dosage, the more likely it will be detected during a drug test.

Frequently Asked Questions About “What is a Comprehensive Drug Test”

Conclusion: The Importance of Comprehensive Drug Testing

Comprehensive drug testing is a critical tool for ensuring a safe and productive workplace. With comprehensive drug testing, employers can proactively tell if employees and prospective employees are using substances that could impact their job performances—and their overall well-being. Proactive drug testing can also help organizations avoid the costs and liability associated with drug use in the workplace, which costs companies billions of dollars every year.

Acuity’s comprehensive drug testing services are available 24/7, wherever and whenever they are needed. Featuring Medical Review Officers and Medical Review Officer Assistants with decades of experience, Acuity’s drug testing services are ideal for all industries, whether they require regulated or unregulated testing.

Learn more about how Acuity can help you meet your drug testing needs.

Why is OSHA necessary? Put simply, the Occupational Safety and Health Administration (OSHA) saves lives. Since 1970, OSHA programs have reduced work-related fatalities by almost 63% and cut workplace injuries by 40%.

Created under the Occupational Safety and Health Act of 1970, OSHA equips employers and workers with the knowledge and tools they need to ensure a safe and healthy workplace. OSHA sets and enforces employer standards and responsibilities and provides compliance assistance, education, and training to ensure those obligations are met.

This blog explores the role that OSHA plays in employee health and safety as well as resources and tools that can help you achieve OSHA compliance.

OSHA Demystified: The Beacon of Workplace Safety

According to the U.S. Bureau of Labor Statistics, employers report 2.6 million injury and illness cases and 5,190 work fatalities a year.

OSHA requires you to safeguard your workforce, but your employees also expect you to do so. Recent survey data reveals that 75% of workers are more likely to remain loyal to a company that prioritizes their physical safety.

The Importance of Occupational Safety

OHSA’s occupational safety programs help reduce falls, slips, trips, vehicular and machinery-related incidents, exposure to chemical and hazardous materials, and more.

But OSHA also plays an important part in workplace productivity and cost management. Work-related injuries and illness are a leading cause of absenteeism, lost productivity, emotional and psychological costs, and workers’ compensation claims volume.

Proactive changes that improve workplace safety can result in significant improvements to your organization’s productivity and financial performance. According to OSHA:

• Companies spend $170 billion each year on costs associated with workplace incidents.
• Workplace health and safety programs lower injury incidences from anywhere between 9% and 60%.
• These programs can also reduce injury and illness costs by up to 40%.

The Genesis of OSHA: A Timeline of Transformation

In 1970, a staggering 14,000 U.S. workers were killed on the job – that’s 38 people every day. But these numbers were not new. For decades, thousands of workers lost their lives or faced hardship because of workplace injury and illness.

Finally, in response to pressure from labor unions, employers, and their families, in December 1970, the U.S. government passed the Occupational Safety and Health Act. In April 1971, OSHA opened its doors.

OSHA is a national agency dedicated to the basic proposition: no workers should have to choose between their life and their job.

OSHA has progressed from representing 56 million workers in 1971 to 105 million private sector workers today. These workers look to OSHA for guidance on workplace health and safety and to their employers to share information on workplace hazards and how to protect themselves.

Catalyst Events: The Urgent Calls for Change

Workplace health and safety first came under the spotlight with the Industrial Revolution and societal shifts like the formation of labor unions, civil rights, women’s rights, and the Vietnam War. However, a series of workplace tragedies and associated public outcry were instrumental in shaping OSHA, including:

• Triangle Shirtwaist Factory Fire: In 1911, 146 people were killed following a fire in a clothing factory in lower Manhattan. The factory lacked a sprinkler system, had all exit doors locked, and possessed only a single fire escape. Employees tragically lost their lives as they tried desperately to escape, succumbing to smoke inhalation, crushing injuries, or falls from windows.
• Hoover Dam Construction: The 1930s construction project caused the death of 96 workers, although unofficial reports cite dozens more fatalities.
• Texas City Industrial Disaster: In 1947, a docked freighter containing a cargo of ammonia nitrate caught fire and exploded. The blast leveled 1,000 buildings, including oil storage facilities and hundreds of homes, and killed almost 600 people. The tragedy is considered one of the largest industrial disasters in history.
• Farmington Mine Disaster: In 1968, an explosion at the Consol No. 9 coal mine in Farmington, West Virginia trapped and killed 78 underground miners. Recovery efforts continued for nearly 10 years but only 59 bodies were recovered.

Read more from the Centers of Disease Control (CDC) about the workplace tragedies that occurred before the passage of OSHA.

The Real-World Impact of OSHA: Stories from the Ground

Since OSHA was established, workplace fatalities, injuries, and illnesses have been cut dramatically. OSHA proudly shares examples of success stories of OSHA-compliant employers.

Voices of Change: Testimonials and Experiences

Here are just a couple of examples of companies that have taken advantage of OSHA’s on-site consultation program and operate exemplary safety and health programs.

Lifecore Biomedical, Inc, Minnesota

Lifecore Biomedical is a fully integrated contract development and manufacturing organization focused on sterile, injectable-grade pharmaceutical drugs and medical device products. The company employs 450 workers worldwide.

Following a routine OSHA inspection in 2003, the company learned about the Minnesota OSHA Workplace Safety Consultation (WSC) Program. WSC works with employers at no cost to help them improve workplace health and safety. Based on WSC’s recommendations, Lifecore implemented several improvements including routine safety audits, fall prevention measures, a safety on-boarding process for new hires, and team-based incident and near-miss investigations.

Results: With OSHA and WSC’s assistance, Lifecore has reduced injury rates by 66% and decreased its days away, restricted, or transferred (DART) rate by 73%. Read more.

Grenzabach Corporation, Georgia

Grenzabach is a German-owned material handling manufacturer with 100 employees at its Newnan, Georgia facility. Prior to 2012, the plant was averaging five recordable injuries per week. Despite a robust commitment to health and safety, additional measures were needed.

To help identify workplace hazards, the company reached out to Georgia’s OSHA On-Site Consultation Program and Tech Safety, Health, and Environmental Services (SHES) program.

Following an on-site assessment visit, Grenzabach mitigated all health and safety issues. It also pursued OSHA’s Safety and Health Achievement Recognition Program (SHARP) certification. Small businesses that achieve SHARP status receive a deferral from OSHA or the State Plan programmed inspections for the period that the SHARP designation is valid.

Results: Since making these changes, the number of recordable incidents at the plant has decreased by 85%. In 2020, the company completed an entire calendar year with zero recordable injuries. Read more.

OSHA’s Multidimensional Approach to Safety

From proactive training to rigorous compliance checks, OSHA offers a great deal of information and assistance to employers to help them comply with their health and safety responsibilities.

The Power of Prevention: OSHA’s Proactive Initiatives

OSHA’s forward-thinking programs help employers preemptively address potential hazards. Tools and resources offered by OSHA include:

• Guidance on establishing a safety and health program.
• Compliance assistance specialists.
• No-cost on-site safety and health consultation services for small businesses.
• Cooperative programs: Businesses, labor groups, and other organizations can work with OSHA to prevent fatalities, injuries, and illnesses in the workplace.
• Occupational safety and health training.
• OSHA educational materials.

OSHA and Healthcare: A Critical Intersection

According to OSHA, more workers in the healthcare industry are injured than in any other. In 2020, the sector reported a 40% increase in injury and illness cases.

Healthcare workers face many safety and health hazards including airborne and bloodborne pathogens, chemical and drug exposures, waste exposures, ergonomic risks such as repetitive and heavy lifting tasks, workplace violence, and more.

In addition to being dangerous, these injuries come at a high cost to employers. Nationwide workers’ compensation losses result in a total annual expense of $2 billion for hospitals.

For these reasons, OSHA has developed specialized standards for healthcare that include safety and health management systems, safe patient handling, and workplace violence.

Navigating the Healthcare Labyrinth: Best Practices for Compliance

Because of the high-risk nature of this sector, OSHA offers a range of tools and resources to help hospitals and healthcare employers align with OSHA standards. Check out OSHA’s Worker Safety in Hospitals website for information including:

• Tools for assessing and advancing a culture of safety.
• A “How Safe is Your Hospital?” questionnaire and safe patient handling assessment.
• Facts about who is most at risk and what hospitals can do to address the problem.
• How health management systems work, save money, and improve quality of care.
• A roadmap for preventing workplace violence.
• And more

Acuity International & OSHA: Pioneering a Safer Tomorrow

Acuity International is committed to championing OSHA standards. Whatever industry you’re in, we can deliver tailored, one-stop occupational health services – whenever and wherever those services are needed.

Our innovative and diverse occupational health services include pre-placement, medical, return-to-work, fit-for-duty, and wellness exams, as well as drug and alcohol testing, respirator fit testing, injury prevention services, COVID testing, vaccinations, and more – delivered via mobile and onsite options.

These cost-effective solutions are backed by robust, centralized health analytics for ease of case management, including real-time exam tracking and reporting, data management and transmission, physician medical review services, and more.

FAQs: Unraveling the Essentials of OSHA

The Undeniable Necessity of OSHA: Reflecting on Why OSHA is Necessary for the Future of Occupational Safety

OSHA is a necessity to aid in the prevention of workplace fatalities, injury, and illnesses. But an OSHA-compliant workplace is also sound business. OSHA programs reduce costs related to injury and illness. Prioritizing occupational safety also gives you a recruiting edge, decreases absenteeism, increases productivity, and enhances employee satisfaction.

OSHA has overseen dramatic improvements in workplace safety over the last five decades, and in a post-COVID pandemic workplace, OSHA’s role is more important than ever.

Learn how Acuity’s occupational health services can help you maintain a healthy, safe, and productive workforce and stay OSHA compliant.

Design and construction projects are dynamic. Costs can change rapidly, and project design can deviate at any moment, impacting planning, schedules, and budgets. Many companies have adopted cost engineering strategies to minimize risk and uncertainty throughout the construction process and ensure optimum costing and coordination of projects and programs.

In this blog, we explore what cost engineering is, why it’s important, tools and techniques that cost engineers use, and tips for starting a career in cost engineering.

Origins and History of Cost Engineering

Cost engineering originated as a project management practice in the 1950s in reaction to the increased complexity of building, construction, and infrastructure projects.

It was formally recognized in 1956 with the establishment of the Association for the Advancement of Cost Engineering (AACE International), which represents practitioners and drives thought leadership in the field.

In 2006, AACE published a Total Cost Management (TCM) Framework. The framework established a proven methodology for managing costs throughout the lifecycle of any construction project. It is a structured, annotated process map that explains each practice area of the cost engineering field in the context of its relationship to other practice areas including allied professions.

Fundamentals of Cost Engineering

Cost engineering involves the application of engineering principles and business acumen to enhance decision-making and reduce risks across the lifecycle of a construction project. Specifically, cost engineering helps builders and contractors understand the scope of a project and associated costs and avoid cost overruns.

Cost engineering services can benefit any sector that deals with complex projects and cost pressures, including government agencies (civilian and defense) and industries including automotive, commercial builders, civil engineering, oil and gas, chemical, manufacturing, healthcare, and more.

The Core Concepts

Cost engineering is an interdisciplinary practice that intersects the fields of project management, engineering, and business management. Think of it as an adjunct to the traditionally technical side of engineering, emphasizing the interplay between different facets of an engineered project, such as expenses, timelines, and resources.

Cost engineering encompasses a wide range of cost-related aspects of engineering and program management including cost estimating, cost analysis, cost assessment, schedule analysis, planning, and risk assessment.

Without the benefit of cost engineering, project owners and contractors may lack clarity in project planning and execution, which can jeopardize project timelines and budgets and make it difficult to respond to variables such as unexpected delays, price increases, or change orders.

Cost Engineering Techniques

Cost engineers use software and other industry tools and resources to collect, analyze, and share cost data.

Tools aside, choosing the appropriate cost engineering technique is critical. Techniques and methodologies can vary depending on several factors, including:

• The scope and complexity of the project
• Project phase and maturity
• Industry and project type
• Stakeholder requirements

Importantly, cost engineering incorporates lessons learned from previous project experience and data-driven insights to provide an early understanding of design and construction decisions and risks. With these insights, mitigative actions can be recommended to ensure successful project outcomes. For this reason, choosing a cost estimation method also depends on the skills and experience of the cost engineer.

Skills and Qualities of a Successful Cost Engineer

To be successful, a cost engineer must have strong analytical abilities, industry-specific knowledge, experience with cost estimating systems, and excellent communication skills. An understanding of professional engineering principles is also desired and many cost engineers have significant prior engineering experience.

Importance of Cost Engineering in Construction

Why is cost engineering important in construction? Consider the following:

Benefits in Construction Projects

Design and construction projects are dynamic. Expenses can fluctuate rapidly, and project designs can veer off course at any point, affecting project planning, timelines, budgets, and profitability. Cost engineering can help owners/builders prepare for risks and uncertainties using engineering techniques, practices, and skillsets to predict project progress and identify deviations from plans.

While projects can be cost-engineered at any stage, the earlier in the planning and design stages the better. This is where cost engineering creates the most value – making the best use of the available budget and resources.

But it shouldn’t end there. Construction project owners can keep their projects on track and within budget by applying cost engineering principles and methodologies across the entire project lifecycle.

While cost engineering offers numerous benefits in managing project costs effectively, a solid foundation in construction budgeting is indispensable. Explore our detailed guide on Mastering Construction Budgeting to ensure your projects are not just well-engineered but also financially sound.

Real-World Examples

Effective cost engineering can make the difference between the success or failure of a construction project. Organizations that embrace the benefits of cost engineering can meet mission objectives and complete projects on time, on budget, and to specifications.

Consider the U.S. Army Corps of Engineers (USACE). Acuity’s cost engineers have helped USACE navigate some of the most complex civil works projects and realize value-driven outcomes. For example, Acuity was part of a team that helped the government save millions off the original contractor’s proposed price for the New Orleans West Closure Complex – a floodgate project intended to reduce storm surge risk and ensure flood resiliency.

This project was part of an extensive portfolio of work that Acuity has performed to help USACE control the scope, cost, schedule, risk, and quality of civil works projects. In addition to providing estimating and scheduling support for hurricane protection systems along the Gulf of Mexico, Acuity has conducted a cost schedule risk analysis for shoreline protection in New York and provided project control support for emergency dam repairs in Iraq.

Future Trends and Innovations

Economic forces, supply chain challenges, sustainability goals, and competitive pressures have ramped up the need for owners and operators to identify risks and deliver savings early and often in the design/build process.

There’s no denying its value, but as business needs change so must the practice of cost engineering. Cost engineers must work faster and with greater agility and accuracy – no matter a project’s scale or complexity.

Promising innovations and trends include simulation and AI capabilities, as well as greater collaboration and alignment among stakeholders. For example, the use of cloud-based tools for cost estimation, construction scheduling, and cost management can empower cost engineers to generate more precise forecasts and improve cross-functional collaboration. These tools also enable automated workflows for immediate insights into potential schedule and cost deviations, allowing cost engineers to closely monitor the project’s financial status through dashboard views of project data.

As we look towards future trends and innovations in cost engineering, understanding the role of construction scheduling in project management becomes increasingly important. Ensure your projects are on the cutting edge by integrating the strategies found in our Construction Scheduling Techniques guide.

Role of a Cost Engineer

Let’s look at the role of a cost engineer and the skills and qualities required to be successful in this profession.

Responsibilities and Duties

It is the cost engineer’s responsibility to coordinate, direct and lead estimating efforts to ensure optimum costing and coordination of projects and programs in line with customer

expectations and manufacturing requirements.

To do this a cost engineer will perform several duties, including but not limited to:

• Define cost estimate scope: Define the project scope, time period, phases to be estimated, communication channels, and establish any boundaries for estimates or project requirements.
• Define assumptions or constraints: Identify any schedule or budget constraints, and how those will be resolved.
• Develop cost element structure: Identify everything defined in the scope to be costed.
• Collect and monitor data: Collect and monitor data, manage risks, identify a (if necessary) contingency plan, control changes and communication, measure and report on progress.
• Develop cost estimating relationships: Use cost data to develop formulas/equations entered into the cost model.
• Document approach: Provide documentation for each cost element, indicating sources of data, assumptions used and any other methodology or analysis.
• Customer review: Ensure that all expected costs have been properly presented to the customer for review/approval/acceptance of the estimate.
• Finalize cost estimate: Finalize the cost estimate. Maintain all files and data related to a project.

How to Become a Cost Engineering Professional (H2)

Interested in cost engineering as a career? Let’s look at what’s required and the opportunities afforded by this profession.

Education and Training

Cost engineers usually possess a degree in either civil engineering or business management. To advance into this position, most individuals have accrued four to six years of experience in a related field, often serving as project engineers, project managers, or engineers. Strong analytical abilities and effective communication skills are essential prerequisites for this role.

To help you chart a career path, consider obtaining a certification in cost engineering, through AACE International’s professional certification program. AACE International also offers a variety of continuing education courses on various cost engineering topics.

Career Path and Opportunities

Cost engineers are in demand. The projected job growth rate is 3% by 2028 with salaries increasing 8% in the last five years. The average salary of a cost engineer is $87, 901 (source).

Given the importance of job experience, look for chances to participate in construction ventures that prioritize cost engineering. Explore opportunities in major urban centers like Atlanta, Dallas, Denver, Houston, and Philadelphia, as well as burgeoning metropolitan areas such as Raleigh and Northern Virginia. Consider high-growth construction sectors where cost engineering is likely to be in demand, including hotels, healthcare and education facilities, critical infrastructure, and smart city construction.

Bringing It All Together: The Blueprint of Cost Engineering

Managing costs and mitigating risk throughout the project lifecycle is key to any successful construction project.

With accurate cost engineering services, project owners ensure their projects stay on schedule and on budget – even in the face of unpredictable economic headwinds and supply/demand challenges.

A career in cost engineering is a promising one. With high earning potential and experience gained across an exciting range of projects, you can develop and apply a wide range of skills. You can also learn about cutting-edge technology, project management best practices, standards, regulations, and other skills that can increase your value and advance your career.

The time of the month has arrived, you’re feeling emotional and irritable, you’re sleepless, and your skin is breaking out. These are all typical symptoms of pre-menstrual syndrome (PMS). But if you have premenstrual dysphoric disorder (PMDD), your symptoms could be much worse.

PMDD is a life-altering condition that puts women at risk of suicide and requires an accurate diagnosis. There are many ways to diagnose PMDD, including the use of a PMDD saliva test (although the test alone is not conclusive).

Let’s look at what PMDD is, its impact on women’s lives, how doctors test for PMDD, and potential treatment options.

Unraveling PMDD: Beyond the Symptoms

PMDD is a severe form of PMS. Like PMS, it causes both emotional and physical symptoms a week or two before your period.

However, PMDD is far more debilitating. Sufferers report depression, severe anxiety, lack of energy, hopelessness, anger, sleep problems, muscle and joint pain, weight gain, and more. More than a temporary nuisance, these symptoms can lead to significant distress and functional impairment. People suffering from PMDD can develop suicidal thoughts and act impulsively, such as leaving relationships or quitting jobs.

According to the National Institute of Health (NIH), PMDD affects 5% to 8% of women.

The causes of PMDD are not well understood. PMDD is associated with the menstrual cycle but is not classified as a hormonal imbalance. Instead, NIH researchers have identified PMDD as a hyper-sensitive response in the brain to the regular hormonal fluctuations that occur during the monthly menstrual cycle.

PMDD is also worsened by factors such as genetics, smoking, prior trauma, and stress. Research is ongoing into the causes of PMDD, but researchers believe that a combination of these factors typically triggers PMDD.

Saliva Tests: The New Frontier in Hormonal Diagnosis

Because of PMDD’s life-impacting nature, it’s important to obtain the right diagnosis. Saliva tests are the gold standard for tracking a woman’s hormone levels, but they cannot diagnose PMDD.

That’s not to say PMDD saliva tests are without value. When combined with other diagnostics, a PMDD saliva test can be used to rule out underlying disorders, such as hormone imbalances or endocrinological conditions, and can provide helpful insights to guide treatment decisions.

How Saliva Tests Work

Saliva tests measure the level of hormones circulating in a woman’s body and are more accurate than blood tests at detecting excess or deficient hormones.

PMDD saliva tests are non-invasive. You simply spit into a test tube or swab your mouth and the sample is sent to a laboratory for analysis. For an accurate diagnosis, saliva samples should be collected at multiple intervals to measure changes in hormone levels over time.

Benefits Over Traditional Testing Methods

Saliva tests are generally considered more useful than blood tests for detecting hormonal imbalances. This is because saliva contains many hormones, such as estrogen and cortisol.

PMDD saliva testing is also convenient and cost effective. Patients can easily collect multiple samples at various moments of the day or month without incurring the cost, inconvenience, and invasiveness of blood testing.

Myths and Realities: PMDD and Saliva Tests

Managing PMDD requires an accurate diagnosis. But due to a lack of information about PMDD, many medical providers overlook the importance of a PMDD saliva test. Instead, women are often advised to track their symptoms a week or two before their period for a span of at least two menstrual cycles.

For a doctor to confirm PMDD, a woman must experience at least five very specific symptoms, such as acute depression, difficulty concentrating, feeling overwhelmed, irritability, and a change in appetite. It may be possible for your doctor to rule out PMDD if these symptoms do not interfere with your everyday life or occur outside the two weeks before your period.

It’s very important to get a PMDD diagnosis right because treatments are quite different to PMS or other mood disorders. If you think you’re experiencing symptoms, talk to your doctor about the value of adding a PMDD saliva test to your diagnostic process.

PMDD in the Workplace

Because women experience nine to twelve periods a year, the impacts of PMDD are long-term and far reaching. A person with PMDD may struggle to concentrate, maintain interpersonal relationships, multitask, and even perform basic workplace tasks without feeling exhausted, angry, or overwhelmed.

Awareness of PMDD and proper treatment are key to helping sufferers manage their conditions.

Natural Remedies: Are They Effective?

There are a variety of treatments for PMDD, the most effective being lifestyle changes such as eating a well-balanced diet, regular exercise, and rest and relaxation. Mood-stabilizing medications like antidepressants can also help.

Talk to your doctor about the right combination of methods. Connect with peer groups; for example, the International Association of Premenstrual Disorders (IAPMD) offers several options including video support groups, crisis referral, email support, a forum, and Facebook groups. Sharing experiences and remedies is important when dealing with this very serious yet often misunderstood and under-diagnosed condition.

FAQs About PMDD Saliva Test

PMDD Saliva Test: Decoding the Future of Diagnosis

PMDD is a very serious condition that affects 5% of women. Unfortunately, medical providers lack understanding of PMDD and confuse it with PMS, so sufferers are rarely offered diagnostic or treatment options.

For these reasons, it’s important that women advocate for themselves. If a doctor can’t help you get a diagnosis, find another.

Advancements in testing, including PMDD saliva testing, can help improve current approaches to diagnostics.

If you’re suffering and believe PMDD is the cause, talk to your doctor about tracking your symptoms and available diagnostics.

PMDD is a diagnosis that impacts the workplace. Learn more about how Acuity’s Occupational Health Services, including our Absence Case Management Services, can help your organization manage short- and long-term leave related to PMDD.

Construction budgeting is a crucial component of any construction project. A construction budget is a cost estimate that outlines the anticipated costs and expenses associated with a project – however large or small.

A construction budget helps builders and owners stay on track financially, supports client relationships, and guide decision making from project inception through closeout.

In this blog, we explore the opportunities and challenges presented by construction budgeting and go into detail about how to develop a construction budget (plus pitfalls to avoid).

Understanding the Basics of Construction Budgeting

Here’s a high-level overview of the basics of construction budgeting and why it’s important.

What is Construction Budgeting?

Construction budgeting is critical to the planning process of any project. Budgeting helps owners and builders understand the scope of the project and associated costs and avoid cost overruns.

Although the terms “construction budget” and “construction project budget” are used interchangeably, they are different:

• A construction budget is an estimate of the overall costs incurred during the physical construction of a building or infrastructure asset. A construction budget includes the cost of lumber, steel, concrete, HVAC, wiring, windows, etc.
• A construction project budget encompasses every cost essential for the realization of the project, including financing, permits, legal expenses, site planning, fixtures, furnishings, and more.

Why is Construction Budgeting Important?

A construction budget is important for several reasons. It can help control costs, highlight project risks, assist in decision making, facilitate communication with project stakeholders, and ensure profitability.

Without a well-planned budget, project owners and contractors may lack clarity regarding project timelines, risk overhead costs, and cost overruns, and struggle to plan for variables (such as unexpected delays, price increases, or change orders).

Key Components of a Construction Budget

A construction budget is composed of two types of costs: direct and indirect. While these form the foundation of a budget, cost estimators must also set aside contingency funds for unexpected events.

Direct Costs to Construction

Direct construction costs are budget items that are tied directly to a specific project. Examples include labor, materials, equipment, subcontractors, and more. Each has a direct impact on the profitability of a project.

Indirect Costs to Consider

Indirect costs include expenses that aren’t unique to a specific project. Examples include administrative expenses, insurance, utilities, rent, etc. Indirect costs have a greater impact on a construction company’s bottom line than direct costs.

Contingency Funds

Contingency funds are budget categories designated for variable or unexpected costs, such as overtime labor expenses or unexpected increases in construction material prices during the course of a project. Construction owners and contractors should allocate reserves specifically for these unforeseen expenditures.

Types of Budgets in Construction

Construction budgets can be categorized into two main types: annual budgets and project budgets.

Two Main Types of Budgets

1. Annual budget: Every construction company should have an annual budget. This encompasses anticipated earnings, cash flow, project costs, payroll, and other business expenses.
2. Project budget: A project budget is created for each specific job. It is an estimate of project costs, including labor, materials, equipment, and other project expenses.

Creating a Robust Construction Budget

Creating a construction budget is a massive undertaking. Even the most experienced cost estimators can struggle to account for the variables and unexpected costs that arise on a project. Follow these steps to create a construction budget:

Steps to Create a Construction Budget

1. Project research: Start by researching and analyzing the project goals and requirements. Assess site conditions, zoning and permit requirements, and any project documentation. This will aid in evaluating the feasibility of the project.

To ensure ease and accuracy, use a historical construction budget template as your guide. See where certain costs went over budget and account for them in your rough draft.

2. Project scope: Meet with the project’s architects and engineers to understand and determine the scope and design options for the project. Create a list of materials needed. Reach out to subcontractors and suppliers to determine the feasibility of the timeline.

3. Pre-construction and documentation: Meet with all stakeholders (contractors, architects, etc.) to discuss the project and review the budget in detail, flag any issues, and develop mitigation strategies. This phase is critical to reducing risk, such as cost overruns, from the start of the project and ensuring the budget and timeline remain on track. Document your discussions (both internal and external).

In addition, gather and securely store all project documentation, including permits, contracts, deliverables, and so on.

4. Construction and project closeout: Revisit your budget often during the construction phase. Monitor building and associated costs to ensure alignment with projected costs and schedules. Identify any problems and develop workarounds as needed. Maintain a change order log so that any deviations from the budget or schedule are tracked. You should also track deliverables and any materials used so that you can pay your contractors on time. Templates, such as a project closeout checklist of time and materials, can help you manage these steps.

Role of a Construction Project Manager

Project management is critical to ensuring that any construction project – regardless of size – is executed successfully, on time, on budget, and to the highest quality standards.

A construction project manager is responsible for leading each phase of the construction process. They develop the project plan, assist with budget planning, coordinate resources, and collaborate with stakeholders and team members to achieve the desired outcomes.

Budget Follow-Up and Monitoring

Construction project managers also oversee budget follow-up. This position involves monitoring project budgets and project finances, making adjustments to accommodate risks, and ensuring the project stays on schedule.

Effective budget monitoring goes hand in hand with efficient project scheduling. Enhance your project management prowess by exploring our essential guide on Construction Scheduling Techniques for Effective Project Management, where you’ll find strategies to keep your projects on time and within budget.

Modern Tools & Software for Construction Budgeting

The accuracy of your construction budget can make the difference between completing the project within the designated timeframe and budget or causing your company to lose money. Greater accuracy can be achieved using digital tools and software for construction budgeting.

Digital Solutions for Accurate Budgeting

With modern digital tools, you can centralize and access all the information you need to make critical decisions. Useful tools for construction budget management include:

• Construction scheduling tools: These tools include built-in templates for accurate scheduling. Automated workflows can alert teams to changes in schedules and potential cost overruns in real time. Furthermore, many construction scheduling tools include dashboard views that keep all stakeholders informed, from planning to project closure.
• Construction estimation and cost management software: This software integrates contract management, payment management, and change management into a single platform. Using cost management software, project managers and cost estimators can develop accurate estimates and forecasts, keep track of any project’s financial health, and ensure teams have easy access to accurate project information throughout the lifecycle.
• Construction reporting: Construction reporting software can help with managing multiple construction projects. Dashboard views provide a single viewpoint into cost and financial data and can be customized as needed.

Challenges and Solutions in Construction Budgeting

Construction budgeting is important, yet it is not without its challenges. Budgeting mistakes are surprisingly prevalent, and unforeseen occurrences like scope expansion can lead to cost overruns if not adequately addressed during the planning phase.

Overcoming budgeting challenges is just one piece of the puzzle. Discover the comprehensive approach of cost engineering to ensure project success. Read our detailed guide on Cost Engineering: Beyond Budgets to Building Success and take your project management skills to the next level.

Common Hurdles in Budgeting

Consider the following case studies:

• Oregon Capitol construction quietly edges $90 million over budget: In August 2023, Oregon lawmakers quietly approved a $90 million cost overrun for a Capitol renovation project, increasing spend on the project by 25%, without notifying the public. The measures will see taxpayers pay approximately $465 million for a $375 million job. Project managers blame inflation (to the tune of $27 million) and growth in project scope for the cost overrun.

• Elementary school construction project costs reduced, but still over budget: The East Lycoming School Board in Pennsylvania recently received a revised construction cost estimate of $37 million for the redesign of Joseph P. Ashkar Elementary School in Hughesville, PA. This amount exceeded the initial estimate and surpassed the available budget allocated by the district.

Architects are now looking into cost-saving measures, including removing the district gym from the project scope and using less costly building materials. The project will be put out to rebid before the deadline for the use of a $25 million bond issue before the project expires. Dr. Mark Stamm, superintendent, noted “The clock is ticking.”

How to Avoid Construction Budgeting Pitfalls

There are always risks in construction budgeting, but pitfalls can be avoided by adhering to the following guidelines:

• Define budgets and schedules early: Inaccurate estimates can be avoided by defining budgets and schedules early in the project phase, without rushing the process.
• Foster proper client communication: Maintain strong relationships with clients by documenting the scope of work and maintaining close communication and transparency throughout the project to mitigate potential issues.
• Plan for contingencies: Plan for unexpected events such as scope creep and change orders to improve estimates and minimize cost overruns.
• Learn from past challenges: Analyze projects that faced challenges due to poor budgeting and apply lessons learned.

You don’t have to tackle this alone. Consider seeking guidance from an expert skilled in precise cost estimation to help you navigate budgeting challenges more effectively. Additionally, utilizing construction software can enhance budget accuracy, improve forecasting, facilitate project collaboration, and streamline issue resolution.

FAQs on Construction Budgeting

Laying the Foundation: The Power of Effective Construction Budgeting

A construction budget should be at the center of any construction project – from the research phase through project closeout. Getting it right leads to positive outcomes for construction firms, owners, and the taxpaying public.

Acuity can help you achieve your cost goals for construction projects, make informed decisions, and minimize risks. Our comprehensive cost engineering services, advanced technology, cost engineers help project owners manage complex, dynamic, and budget-constrained construction projects.

Contact us to learn how our cost engineering services can help you optimize construction project budgets and reduce risks.