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Form MCSA-5875 (Revised: 10/02/2015) OMB No. 2126-0006 Expiration Date: 8/31/2018 Public Burden Statement A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor
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Form MCSA-5875 revised 10022015 is the Medical Examination Report for Commercial Driver Fitness Determination.
Commercial drivers are required to file form MCSA-5875 revised 10022015.
Form MCSA-5875 revised 10022015 should be filled out by a certified medical examiner after conducting a physical examination of the commercial driver.
The purpose of form MCSA-5875 revised 10022015 is to determine the medical fitness of commercial drivers to operate vehicles.
Form MCSA-5875 revised 10022015 must include the results of the physical examination, medical history, and any medical conditions that may affect the driver's ability to operate a commercial vehicle.
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