Regulatory Alert: Effective January 16, 2024,
The FMCSA revised its Medical Examinerโs Certificate and Medical Examination Report Form to remove an obsolete reference. The new forms may be identified by a revision (rev) date, respectively, of โ3/1/23โ and โ2/28/2023โ in the lower corner (the date in the upper corner remains 3/31/2025). The FMCSA is allowing medical examiners to use up their existing stock of older forms, and is encouraging state licensing agencies to continue accepting them, beyond the January 16 deadline. However, motor carriers and medical examiners are advised to switch to the new forms as soon as possible.
- Helps you comply with 49 CFR ยง391.43
- Form MCSA-5875
- Both the Medical Examination Form and Medical Examination Certificate are required by the DOT
- This DOT medical examination form is 9 pages long
- Contains applicable regulations, instructions to the medical examiner, and the form itself
- Measures 8-1/2" x 11โ
View Sample
View a sample Medical Examination Report.
Number of Plies: 1
Compliance Topic: Injury & Illness Recordkeeping, Driver Qualification & Hiring
Size: 8.5" x 11"
Format: Sheet
Need to Purchase a Case?: 500 per case
Industry: Transportation, Human Resources
Average Rating: 4.8
BVNumberOfReviews: 6
Country Of Origin: USA