DoT MCSA-5875 2013 free printable template

Form MCSA-5875 Revised 04/01/2013 OMB No. 2126-0006 Expiration Date Public Burden Statement A Federal agency may not conduct or sponsor and a person is not required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0006. Public...

How to fill out DoT MCSA-5875

How to fill out DoT MCSA-5875

1. Download the DoT MCSA-5875 form from the official website.
2. Read the instructions carefully to understand the requirements.
3. Provide the company name and address in the designated fields.
4. Indicate the type of operation (e.g., interstate, intrastate).
5. Fill out the section regarding the type of vehicle(s) operated.
6. Complete the sections related to the number of drivers and their qualifications.
7. Include any safety records, if applicable.
8. Review the entire form for accuracy.
9. Sign and date the application where indicated.
10. Submit the completed form to the appropriate department.

Who needs DoT MCSA-5875?

1. Motor carriers operating commercial vehicles in the United States.
2. Companies that transport goods or passengers across state lines.
3. Businesses applying for operating authority from the U.S. Department of Transportation.
4. New or existing transportation companies seeking compliance with federal regulations.

People Also Ask about

What is a MCSA 5876 form?

If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in ance with the physical qualification standards, the Medical Examiner will complete and provide the driver with a Medical Examiner's Certificate (MEC), Form MCSA-5876.

What do they test in urine for DOT physical?

The DOT drug test will screen for cocaine, amphetamines, opioids, THC, marijuana, and PCP. If the driver tests positive for any of these drugs, additional follow up may be required to determine if there is an alternative medical explanation for the substances which were identified.

What are the requirements for a DOT physical in PA?

The DOT physical requires drivers to have 20/40 vision with or without the use of corrective lenses. This means you must be able to see at least 20/40 with both eyes, or at least 20/40 with either the right eye or left eye. Those with monovision may be disqualified from getting a DOT medical card.

What does a DOT physical consist of in Pennsylvania?

What Does this Exam Consist of? A DOT Physical evaluates a driver's vision, blood pressure, and a complete review of their medical history. This can help ensure that a driver does not have certain health conditions and can safely operate a commercial vehicle.

How do I get a PA DOT medical card?

In Person: At your local PennDOT Driver License Center. PennDOT will mail you a receipt indicating that the Medical Examiner's Certification and/or Self-Certification Form has been processed.

What is the full form of Mer in medical exam?

Medical Examination Report (MER) Form, MCSA-5875.

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What is DoT MCSA-5875?

The DoT MCSA-5875 is a form used by the Department of Transportation (DOT) that is related to the medical examination of commercial motor vehicle drivers. It serves as a record of the driver's medical history and the examination results.

Who is required to file DoT MCSA-5875?

Drivers of commercial motor vehicles who are subject to federal regulations must file DoT MCSA-5875 as part of their medical certification process. This includes drivers who operate vehicles that fall under the DOT's guidelines for commercial driving.

How to fill out DoT MCSA-5875?

To fill out DoT MCSA-5875, drivers must complete their personal information, provide details about their medical history, and undergo a physical examination by a certified medical examiner. The examiner then signs the form, certifying that the driver meets the necessary medical standards.

What is the purpose of DoT MCSA-5875?

The purpose of DoT MCSA-5875 is to ensure that commercial drivers are medically qualified to operate heavy vehicles safely. It helps in preventing accidents related to medical conditions that could impair a driver’s ability to drive.

What information must be reported on DoT MCSA-5875?

DoT MCSA-5875 requires the reporting of personal identification information, medical history, current medical conditions, medications, and the results of the medical examination, including a certification statement by the licensed medical examiner.