Product Information
Used by motor carriers to document the required verification that their medical examiners are qualified to conduct drivers' physical exams.
- Helps you comply with DOT's 49 CFR §391.23 and §391.51
- Use each time a commercial vehicle driver undergoes a DOT medical exam
- Includes fields to enter the following information:
- Driver's Name and Identification Number
- Certificate Expiration Date
- Medical Examiner and National Registry Number
- Motor Carrier and Location
- Motor Carrier Representative Signature and Date
- Snap out format
- Two plies
- Carbonless
- Measures 8-1/2" x 11-3/4"
Specifications
Carbon Type: Carbonless
Number of Plies: 2
Compliance Topic: Injury & Illness Recordkeeping, Driver Qualification & Hiring
Size: 8.5" x 11.75"
Format: Snap-out
Need to Purchase a Case?: 2,000 per case
Industry: Transportation, Human Resources
Country Of Origin: USA
Reviews
Questions & Answers