Academy of Occupational and Environmental Medicine, Malaysia

Assistant Medical Review Officer

(AMRO)

AMRO Certification Course 2022

© 2022 AOEMM
All rights reserved. No part of this document may be produced, stored in a retrieval system or transmitted in any
form or by any means (electronic, mechanical, photocopying, recording or otherwise) without permission of the
copyright owner.

Outline
1. Drug & Alcohol Testing Process

2. Common D&A Testing Issues

3. Roles and Responsibilities of AMRO

4. Conclusion

1
 Drug Testing Process
Selection &
Donor Selection
Preparation of
& Notification
Collection Site
AMRO
Sample Collection
& Handling

Point of Collection Non- Laboratory

Negative
(POC) Testing Negative Testing

Negative Positive

MRO Negative
STOP
Verification
STOP
Positive
Consequence Notification
Management to Employer 3

Alcohol Testing Process

Donor Selection &

Notification
Positive
Breath Screening Result Confirmatory test

Selection &
Preparation of (Negative)
Collection Site
Negative
STOP Result

Positive

AMRO Consequence Notification

Print result
Management to Employer

Academy of Occupational and Environmental Medicine, Malaysia (AOEMM) 4

2
 D&A Testing Types

• Pre-employment testing
• Pre-placement testing
• Random testing
• Mass screening
• Testing for cause
• Post-incident testing

Drug Testing Issues

• Errors may occur at every stage of the testing

process.
• Most errors occur during sample collection,
packaging and transportation of samples.
• Fatal errors and uncorrected errors will invalid
the test or the subsequent result.
• Errors may result in unfair disciplinary action to
affected employees and potential litigation by
them.
6

3
 Sources of Errors

Urine Equipment Other Problems

Wrong urine Not calibrated Chain of custody
Diluted urine Contaminated
Expired
Damage Storage Transportation
Spiked urine Wrong
ERRORS
Bias Wrong result
Illness Wrong sample
Tampering
Medications Not following
Wrong Donor Not following procedures
procedures
Donor Testers/ Laboratory
Collectors

Academy of Occupational and

7
Environmental Medicine, Malaysia

Who is the AMRO?

A person designated by the Company to carry out the
following activities:
• Urine sample collection for drug testing
• Urine for Point of Collection (POC) drug testing
• Packaging, storage and transporting urine for drug
sample to company appointed/designated laboratory
• Conduct alcohol testing – screening & confirmatory
testing
• Assisting MRO (Medical Review Officer) during urine
for drug verification process
8

4
 Providing Assistance to MRO
• Checking for completeness of documentation
required by MRO for him to do the verification of
test results
• Contacting DER (Designated Employer
Representative) for Donor contact particulars such
as personal phone number, specific personal
information such as mother’s maiden name, etc.
for use during MRO phone interview with Donor
• Contacting the Donor for the purpose of fixing
interview date & time with MRO
Academy of Occupational and
9
Environmental Medicine, Malaysia

AMRO Qualification

• No specific requirement on basic/general

academic qualification.
• Must be trained and competent in drug and
alcohol testing procedures.
• Need to be appointed and authorised by the
employer.
• Refresher training is needed to maintain the
competency; recertification is currently 3
yearly.
10

10

5
 AMRO Responsibilities
• Carry out duties & responsibilities with strict adherence/
compliance to Company policy & procedures.
• Do not get involved in Donor selection and notification,
and escorting of Donor.
• Report to DER on any incident or procedure deviation
during collection, storage and packaging of sample.
• Refer Donor with non-negative result, shy bladder or shy
lung and non-cooperative Donor to DER.
• Keep records of sample collection and on-site testing
proceeding.
• Maintain confidentiality of all information regarding the
testing done. 11

11

AMRO Training
It covers the following;
• DFWP
• AMRO roles and responsibilities
• Drug and alcohol testing process & procedures
• Company substance abuse policy and program
• Company substance abuse testing procedures
• Hands-on training on sample collection & packaging
*Initial sample collection and packaging should be
supervised by a senior AMRO or an MRO.
Academy of Occupational and
12
Environmental Medicine, Malaysia

12

6
 Conclusion
• Substance abuse testing must be error free.
• Sample collection, POC testing, sample packaging
and transportation are potential source of testing
errors.
• Involvement of AMRO in these activities expose
them to problems related to these errors and the
subsequent impacts.
• To ensure errors are eliminated or kept to
minimum, AMRO must be trained, attained &
maintained certain level of competency.
13

13