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Click ‘Get Form’ to open the Medical Examination Report in the editor.
Begin by filling out the DRIVER'S INFORMATION section. Enter your name, Social Security number, birthdate, age, sex, and address. Ensure all fields are completed accurately.
Proceed to the HEALTH HISTORY section. Answer each question regarding past illnesses or injuries by selecting 'YES' or 'NO'. If you answer 'YES', provide additional details as required.
In the VISION section, record your visual acuity results for both eyes. If corrective lenses are used, ensure this is noted.
Complete the HEARING section by indicating your hearing ability and any aids used during testing.
Fill in BLOOD PRESSURE / PULSE RATE with numerical readings taken by a medical examiner.
Finally, review the PHYSICAL EXAMINATION section for any abnormalities and provide comments as necessary before signing the document.
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Here are the requirements for a DOT number: Information about your business (name, location, etc) Personal information (so the FMCSA can contact you about your application) Information about the operation classification you are looking to obtain. Know whether you will transport people or cargo. A valid address.
What documents do I need for a dot physical?
What Do I Need to Bring to a DOT Physical Exam? Current drivers license. Full medical history. List of current medications. FMCSA medical examination report form (optional)
Do you need authority for a DOT number?
In general, companies that do the following are required to have interstate operating authority (MC number) in addition to a DOT number: Operating as for-hire carriers (for a fee or other compensation) Transporting passengers, or arranging for their transport, in interstate commerce.
How to get a USDOT form?
If you file your USDOT application online through the Federal Motor Carrier Safety Administrations online portal, the system will choose the proper form for you.
Who can fill out a dot form?
In order to legally sign the DOT number application form, you must be either an owner or partner in the business, an authorized representative or official of the company, or hold power of attorney for the applicant.
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Commercial Drivers: Drivers of commercial motor vehicles, including truck drivers, bus drivers, and delivery drivers, are subject to DOT regulations. These regulations cover issues like licensing, medical qualifications, and drug testing.
How much does it cost to apply for USDOT?
Obtaining a USDOT number is free when registering through the Federal Motor Carrier Safety Administration (FMCSA) website. However, if you also need to apply for operating authority (MC number), there are fees associated with that, typically $300 per authority type.
How much does it cost to get a DOT number?
There is no charge to get a USDOT number. For more information on how to get a USDOT number, please see the FAQ How do I get a US DOT number? For some definitions of FMCSA terms, click here.
Related links
DOT-Medical-Exam-Report-Form.pdf
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