- The Exam at a Glance
- Eligibility and Fee Mechanics
- Blueprint: 72, 40 and 23 Scored Items
- Domain 1 Facts: Clinical Practice and Case Management
- Domain 2 Facts: Risk and Compliance
- Domain 3 Facts: Program Management and Quality Assurance
- Scoring and the Pass-Rate Discrepancy
- How Questions Are Written
- Exam-Day Logistics
- Domain-Weighted Review Schedule
- Recertification Numbers
- Frequently Asked Questions
- The exam has 160 multiple-choice questions in 3 hours: 135 scored, 25 unscored pretest items.
- Scored items split 72/40/23 across three domains; Clinical Practice and Case Management is the largest.
- Total cost is $550: a $150 application fee plus a $400 examination fee.
- Eligibility requires an RN license (or international equivalent) plus 3,000 occupational-health practice hours in the past five years.
The Exam at a Glance
This is a one-page review of the facts that matter most for the Certified Occupational Health Nurse (COHN) credential, awarded by the American Board for Occupational Health Nurses, Inc. (ABOHN). Print it, tape it above your desk, and use it to check whether anything in your preparation is missing. Every number below comes from the March 2026 candidate handbook and ABOHN's published fee, statistics and recertification pages.
| Item | Must-Know Fact |
|---|---|
| Certifying body | American Board for Occupational Health Nurses, Inc. (ABOHN) |
| Test administration | Assessment Systems Corporation (ASC) |
| Delivery | Test center or MonitorEDU live remote proctoring |
| Total questions | 160 multiple-choice |
| Scored / pretest | 135 scored, 25 pretest (unscored) |
| Time allowed | 3 hours |
| Reference materials | Closed-book |
| Fees | $150 application + $400 examination = $550 |
| Standard-setting method | Angoff-based passing standard |
| Recertification | Every five years; $150 annual maintenance/recertification fee |
Candidates often ask how much time they have per question. Three hours across 160 items works out to a little over a minute each, which is comfortable for most clinicians but unforgiving if you reread long scenario stems repeatedly. For a deeper look at difficulty, see How Hard Is the COHN Exam? Complete Difficulty Guide 2026.
Eligibility and Fee Mechanics
Who Can Sit for the Exam
You need a current RN license or an international equivalent, plus 3,000 hours of occupational-health practice within the previous five years. The handbook describes specified education alternatives to part of the practice requirement, but those routes require ABOHN approval, so do not assume an alternative path qualifies until you have confirmation in writing. The full eligibility walkthrough lives in COHN Requirements 2026: Eligibility, Prerequisites & How to Qualify.
What You Pay and When
The cost structure is two separate charges: a $150 application fee and a $400 examination fee, for $550 total. Budget for both up front so the application does not stall. The complete pricing picture, including what recertification adds over time, is in COHN Certification Cost 2026: Complete Pricing Breakdown.
Blueprint: 72, 40 and 23 Scored Items
The official allocation is expressed as scored-item counts, not percentage labels. That distinction matters because the 25 pretest items are scattered through the exam and do not count, so the 135 scored questions break down as follows.
| Domain | Scored Items | Relative Weight |
|---|---|---|
| Domain 1: Clinical Practice and Case Management | 72 | Largest |
| Domain 2: Risk and Compliance | 40 | Middle |
| Domain 3: Program Management and Quality Assurance | 23 | Smallest |
Together that is 135 scored items. Domain 1 carries more scored items than Domains 2 and 3 combined, which is the single most useful fact for allocating study time. For a full breakdown of each content area, read COHN Exam Domains 2026: Complete Guide to All 3 Content Areas.
Key Takeaway
Because you cannot tell which 25 items are pretest, treat every question as scored. The blueprint tells you where your points are concentrated; it does not tell you which questions to skip.
Domain 1 Facts: Clinical Practice and Case Management
Domain 1: Clinical Practice and Case Management (72 scored items)
This is the heart of the exam and the domain where day-to-day occupational-health nursing judgment is tested most heavily.
- Assessing and triaging work-related injuries and illnesses, and recognizing when a presentation is occupational rather than personal
- Case management of injured or ill workers, including coordination with employers, treating providers and payers
- Return-to-work and modified or transitional duty decisions, balancing worker recovery against job demands
- Fitness-for-duty and pre-placement evaluations, and the limits of what information can be shared with an employer
- Health surveillance and medical monitoring tied to workplace exposures
- Health promotion, wellness and prevention at the population level
- Emergency response and first-aid readiness within the workplace
Expect scenarios, not definitions. A typical stem describes a worker, an exposure or injury, and a workplace constraint, then asks for the most appropriate nursing action. Your task is to prioritize safely while respecting confidentiality and the employment context. Since this domain is so large, it deserves the longest stretch of your preparation, a point developed in COHN Study Guide 2026: How to Pass on Your First Attempt.
Domain 2 Facts: Risk and Compliance
Domain 2: Risk and Compliance (40 scored items)
This domain tests whether you can protect workers and the organization within the rules that govern occupational health.
- Occupational safety and health regulations and recordkeeping obligations, including how injuries and illnesses are documented and reported
- Workers' compensation concepts and how they interact with case management
- Hazard identification and the hierarchy of controls, from elimination and substitution through engineering and administrative controls to personal protective equipment
- Exposure assessment concepts across chemical, physical, biological and ergonomic hazards
- Confidentiality, privacy and ethical practice, especially the boundary between employee health information and employer need-to-know
- Disability-related and leave-related legal frameworks as they affect accommodation and return to work
The pattern to recognize here is the hierarchy-of-controls logic: when a question asks for the best way to reduce a hazard, the answer closer to the source (elimination, substitution, engineering) generally beats one that relies on worker behavior or protective equipment. Compliance questions also reward precision about who must report, to whom and within what framework, so study the regulatory vocabulary rather than relying on general nursing instincts.
Domain 3 Facts: Program Management and Quality Assurance
Domain 3: Program Management and Quality Assurance (23 scored items)
The smallest domain is also the one clinicians most often neglect, because it feels administrative rather than clinical.
- Planning, implementing and evaluating occupational-health programs and services
- Using data, such as injury and illness trends, to identify priorities and justify resources
- Quality improvement cycles and measuring program outcomes
- Budgeting, staffing and the business case for occupational-health services
- Collaboration with safety, human resources, industrial hygiene, management and external providers
- Policy and procedure development and documentation standards
Do not dismiss this domain because it has the fewest scored items. Twenty-three questions is still a meaningful slice of a closed-book exam, and the concepts are often unfamiliar to nurses whose experience has been purely clinical. Program-evaluation vocabulary and data-driven decision-making are learnable quickly, which makes this domain a good place to pick up reliable points.
Scoring and the Pass-Rate Discrepancy
ABOHN uses an Angoff-based passing standard, a method in which subject-matter experts judge how a minimally competent candidate would perform on each item. The practical meaning is that your result is measured against a competence standard, not against other test-takers on the same day, and there is no fixed public cut score you can memorize as a percentage.
On the statistics page, ABOHN reports a 65% pass figure for 2025 but also lists 57/85 alongside it. That is an unresolved discrepancy in the published data, and nothing in the source clarifies what the second figure represents. Rather than guess, treat any single pass-rate number with caution and plan to be well prepared regardless. For a careful reading of what the data does and does not support, see COHN Pass Rate 2026: What the Data Shows and COHN Passing Score 2026: Exactly What You Need to Pass.
Key Takeaway
Do not anchor your confidence on a single published pass-rate figure. The data contains an unresolved discrepancy, so the safe strategy is to prepare for competence across all three domains rather than aim for a perceived minimum.
How Questions Are Written
All 160 items are multiple-choice. In occupational-health practice, several answers are often partly defensible, so the exam rewards choosing the best answer for the situation described. A few habits help:
- Identify the role. Are you acting as clinician, case manager, compliance resource or program manager? The correct answer shifts with the role.
- Look for the confidentiality angle. Many scenarios hinge on what you may disclose to a supervisor versus what stays in the health record.
- Prefer the preventive and upstream option when the question concerns hazards, consistent with the hierarchy of controls.
- Respect scope of practice. Answers that exceed nursing scope or bypass appropriate referral are rarely correct.
- Watch for absolute words such as "always" and "never," which usually signal a distractor.
Exam-Day Logistics
ABOHN works with Assessment Systems Corporation (ASC), and you can test at a center or through MonitorEDU live remote proctoring. Choose the format that minimizes risk for you: a center removes home-technology variables, while remote delivery removes travel. If you test remotely, prepare your room and equipment in advance and read the proctoring rules in the handbook, since the exam is closed-book and the environment will be monitored.
For testing windows, scheduling steps and deadlines, check COHN Exam Dates 2026: Testing Windows, Deadlines & Scheduling and confirm all details against the current handbook before booking.
Domain-Weighted Review Schedule
If you have about six weeks, weight your calendar by scored items. This is the one place where methodology belongs, and it is driven entirely by the 72/40/23 split.
Domain 1 Foundations
- Injury and illness assessment, triage and case management
- Return-to-work and fitness-for-duty logic
- Surveillance and health-promotion concepts
Domain 2 Risk and Compliance
- Hierarchy of controls and exposure categories
- Recordkeeping, workers' compensation and confidentiality rules
Domain 3 Program Management
- Program planning, evaluation and quality improvement
- Data trends, budgeting and stakeholder collaboration
Mixed Practice and Weak Spots
- Timed sets that mix all three domains
- Extra review time returned to Domain 1, where most points sit
When you are ready to test yourself under realistic conditions, use the COHN practice tests to find the domains that need another pass.
Recertification Numbers
Earning the credential is not the end of the cost or paperwork. Recertification is on a five-year cycle and requires active RN status, 3,000 practice hours and 50 related continuing nursing education (CNE) hours. ABOHN charges a $150 annual maintenance/recertification fee. Start logging practice hours and CNE from the day you pass so the renewal is a matter of compiling records, not reconstructing them.
If you are weighing the long-term value of keeping the credential current, two companion reads help: COHN Salary Guide 2026: Complete Earnings Analysis and Is the COHN Certification Worth It? Complete ROI Analysis 2026.
Frequently Asked Questions
There are 160 multiple-choice questions. Of these, 135 are scored and 25 are unscored pretest items. You have 3 hours, and the exam is closed-book.
The total is $550, made up of a $150 application fee and a $400 examination fee. A separate $150 annual maintenance/recertification fee applies after certification.
Domain 1, Clinical Practice and Case Management, is the largest, with 72 scored items. Domain 2, Risk and Compliance, has 40, and Domain 3, Program Management and Quality Assurance, has 23.
You need an RN license or international equivalent and 3,000 occupational-health practice hours in the previous five years. Specified education alternatives exist but require ABOHN approval, so confirm before relying on one.
Yes. Delivery through Assessment Systems Corporation is available at a testing center or by MonitorEDU live remote proctoring. Review the handbook's proctoring and environment rules before you choose remote delivery.
For more background on the credential itself, see What Is COHN Certification? and, for career context, COHN Jobs.