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Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years? Have you ever had surgery? If “yes,” please list and explain below.
20 gru 2023 · The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner’s Certificate (MEC), Form MCSA-5876 to drive. As part of the physical, drivers are required to fill out the medical history portion of the Medical Examination Report (MER) Form, MCSA-5875.
9 gru 2015 · Medical examiners are required to complete the Medical Examination Report Form for every driver physical examination performed in accordance with 49 CFR 391.41.
These forms can be completed by typing into the electronic PDF form or by printing the form and handwriting information onto the hard copy. FMCSA does not provide the forms for purchase.
Form MCSA-5875 OMB No. 2126-0006 Expiration Date: 11/30/2021 Please complete only one of the following (Federal or State) Medical Examiner Determination sections: MEDICAL EXAMINER DETERMINATION (Federal) Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49):
DOT Physical Form & Medical Card Certificate, Forms MCSA-5875 & MCSA-5876 in PDF. Free to Print or Download. Includes Instructions to Physician and Commercial Drivers Minimum Requirements for a CDL License.
30 lis 2021 · Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years? Yes No Not Sure. *CLP/CDL Applicant/Holder: See instructions for definitions. **Driver ID Verified By: Record what type of photo ID was used to verify the identity of the driver, e.g., CDL, driver's license, passport. Have you ever had surgery?
