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Form MCSA-5876 (Revised: 03/11/2013). OMB No. 2126-0006 Expiration Date: 07/31/2015. Medical Examiner's Certificate. (for Commercial Driver Medical ...

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How to fill out form mcsa-5876 revised 03112013

To fill out form MCSA-5876 revised 03112013, you need to follow these steps:

01

Begin by providing your full name and contact information in the designated fields. This will help the authorities identify you and communicate with you if necessary.

02

Next, you will need to provide information about your motor carrier. This includes the name, address, and USDOT number of your carrier, as well as the carrier's type and primary contact person.

03

Moving on, you will be required to disclose details about the violation(s) that led to the need to complete this form. Provide accurate information about the incident, such as the date, location, and description of the violation(s) committed.

04

If there were any witnesses present during the incident, their information should be included in the form as well. This may include their names, contact details, and any additional information they can provide about the violation(s) that occurred.

05

Finally, you will need to certify the accuracy of the information provided by signing and dating the form.

5.1

Form MCSA-5876 revised 03112013 is typically required by motor carriers, specifically those who have been involved in safety-related violations. This form allows carriers to provide detailed information regarding the violations and any supporting evidence or witnesses. It is crucial for carriers and their representatives to accurately fill out this form to ensure proper handling of the violation(s) and to demonstrate compliance with relevant safety regulations.

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What is form mcsa-5876 revised 0311?

Form mcsa-5876 revised 0311 is a form used by the Federal Motor Carrier Safety Administration (FMCSA) for medical examination reports.

Who is required to file form mcsa-5876 revised 0311?

Commercial motor vehicle drivers are required to file form mcsa-5876 revised 0311.

How to fill out form mcsa-5876 revised 0311?

Form mcsa-5876 revised 0311 should be filled out by a certified medical examiner during the driver's medical examination.

What is the purpose of form mcsa-5876 revised 0311?

The purpose of form mcsa-5876 revised 0311 is to ensure that commercial motor vehicle drivers meet the medical standards set by the FMCSA.

What information must be reported on form mcsa-5876 revised 0311?

Form mcsa-5876 revised 0311 must include the driver's personal information, medical history, and the results of the medical examination.

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