Free DOT Medical Exam Forms and Templates

What Is a DOT Medical Exam?

A DOT Medical Exam is a thorough physical examination that determines the ability of a Department of Transportation (DOT) employee to operate a commercial motor vehicle (CMV). Since DOT employees can affect their own safety and the safety of the public when performing their jobs, they must have a regular physical to be compliant and continue to fulfill their duties. Check out our library of Medical Exam Forms available for download through the links below.

FMCSA Form MCSA-5875, also known as the DOT Medical Exam Form, is the official document that records the results of the health and safety exam required by the DOT in order for the employee to drive a CMV. It indicates the driver’s health history, contains the results of performed tests, and offers a medical examiner’s conclusion on whether the driver meets the standards set by the Federal Motor Carrier Safety Regulations.

Related forms include:

  1. MCSA-5870, Insulin Treated Diabetes Mellitus (ITDM) Assessment Form, completed by a diabetic driver’s treating clinician who attests the driver has a properly controlled disease.
  2. MCSA-5876, Medical Examiner’s Certificate, filled out by the medical examiner who gives the physically qualified driver permission to drive a CMV.
  3. MCSA-5895, 391.41 CMV Driver Medication Form, a document that provides additional information about prescribed medications for drivers.

What Does a DOT Medical Exam Consist Of?

There are more than 40,000 DOT medical exam locations in the United States. It is possible to get the exam at your primary care doctor’s office but if it is more convenient, refer to your local urgent care clinic.

The examiner will assess your physical and mental health to make sure you do not have any medical conditions that might interfere with your ability to drive and operate a CMV safely. The doctor will perform a series of tests to check your vision, hearing, blood pressure, and other body functions. Sometimes, drug testing and urinalysis for diabetes are included in the exam.

Usually, a physical takes between 30 minutes and one hour. To make sure everything goes smoothly and you do not waste your time, prepare documents and items regarding your existing medical conditions. You are required to disclose all known health conditions and diseases with your doctor at the time of the DOT Medical Exam.

DOT Medical Exam Requirements

A proper DOT Medical Exam follows guidelines created by the Federal Motor Carrier Safety Administration (FMCSA). To drive a CMV, you must first meet the requirements listed below:

  1. Vision. 20/40 correctable in each eye.
  2. Hearing. You are able to hear a whisper from more than five feet away in at least one ear.
  3. Blood Pressure. 140-159/90-99 will give you a one-year MCSA-5876 certificate, 160-170/100-109 guarantees three months certificate.
  4. Blood Sugar. A hemoglobin A1C test is below 10%.
  5. Medications. Medications must not affect your ability to drive a CMV.
  6. Diabetes. Diabetes must be in active treatment under a doctor's supervision.
  7. Cardiac Issues. You can not have any cardiac diseases.
  8. Sleep Apnea. If you have this diagnosis, prepare a release from your physician that demonstrates it is under control.

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This form is used for assessing individuals with insulin-treated diabetes mellitus. It helps gather important information for evaluating the condition and determining appropriate treatment plans.

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