DoT MCSA-5875 2021 free printable template
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Form MCSA5875Expiration Date: 11/30/2021OMB No. 21260006Public 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
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How to fill out DoT MCSA-5875
How to fill out DoT MCSA-5875
01
Obtain the DoT MCSA-5875 form from the official Department of Transportation website or your local office.
02
Fill in the General Information section with details such as your name, mailing address, and contact number.
03
Provide the details of the vehicle or vehicles for which you are applying, including the Vehicle Identification Number (VIN) and license plate number.
04
Indicate the reason for certification by selecting the appropriate box or writing a brief explanation.
05
Review and complete the Vehicle Inspection section, ensuring to list any defects or repairs conducted.
06
Sign and date the form at the designated areas to verify all information is true and correct.
07
Submit the completed MCSA-5875 form as instructed, either online or at your local regulatory office.
Who needs DoT MCSA-5875?
01
Any individual or organization that operates commercial motor vehicles and requires certification for compliance with federal safety regulations.
02
Motor carriers that transport goods across state lines and need to demonstrate fitness for service.
03
Commercial drivers who are applying for a medical certificate as part of their licensing process.
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People Also Ask about
How long must a medical examiner retain a copy of the medical examination report for a qualified driver?
(i) Each original (paper or electronic) completed Medical Examination Report and a copy or electronic version of each medical examiner's certificate must be retained on file at the office of the medical examiner for at least 3 years from the date of examination.
Can I keep my CDL without a medical card in California?
California law requires all CDL drivers to meet Federal Motor Carrier qualification requirements under 49 CFR part 391 and have a valid DOT medical card. You must meet the Federal DOT medical certificate requirements. You must meet the Federal DOT medical certificate requirements.
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 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 is MCSA 5875 & MCSA-5876?
About the Medical Examination Report (MER) Form, MCSA-5875: The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner's Certificate (MEC), Form MCSA-5876 to drive.
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What is DoT MCSA-5875?
DoT MCSA-5875 is a Medical Examination Report Form used by the Federal Motor Carrier Safety Administration (FMCSA) for commercial motor vehicle drivers. It is required to document the results of a driver's medical examination.
Who is required to file DoT MCSA-5875?
Drivers of commercial motor vehicles (CMVs) who are required to obtain a medical certification to operate vehicles that fall under FMCSA regulations must file DoT MCSA-5875.
How to fill out DoT MCSA-5875?
To fill out DoT MCSA-5875, a qualified medical examiner must complete the form during a driver's medical examination, providing details on the driver's medical history, examination results, and assessment.
What is the purpose of DoT MCSA-5875?
The purpose of DoT MCSA-5875 is to ensure that commercial drivers meet the necessary health and safety standards required for operating commercial motor vehicles, thus promoting road safety.
What information must be reported on DoT MCSA-5875?
DoT MCSA-5875 requires reporting information such as the driver’s personal details, medical history, findings from the physical examination, and the medical examiner's certification, including any medical conditions that may affect the ability to drive.
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