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Form MCSA-5876 OMB No - dot-physical-2026

The document is Form MCSA-5876, a Medical Examiner's Certificate used for Commercial Driver Medical Certification by the U.S. Department of Transportation's Federal Motor Carrier Safety Administration. It outlines the requirements for medical examinations of commercial drivers, including necessary qualifications and any applicable exemptions. The form includes sections for the medical examiner's details, driver's information, and certification of the examination results.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the driver's last and first name in the designated fields at the top of the form.
Select one of the options regarding compliance with Federal Motor Carrier Safety Regulations by checking the appropriate box.
If applicable, check any additional qualifications such as wearing corrective lenses or having a waiver/exemption.
The medical examiner must complete their section by signing and providing their details, including telephone number and state license number.
Ensure that the driver’s information is filled out accurately, including their signature, license number, and address.
Review all entries for accuracy before saving or exporting your completed form.

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How to be exempt from dot physical?

Answer: You can contact the Medical Examiner that conducted your evaluation for a copy of your medical certification examination.

What is a medical certificate used for?

Medical examiners must pass a certification test and do refresher training every five years to maintain their status. They must also take a certification test every 10 years.

What is a medical examiners certificate form mcsa 5876?

Having at least three years of commercial motor vehicle experience (and the experience should have occurred immediately before the date you applied for your exemption) Driving for at least 10 hours a week. Having a safe driving record. Having a vision deficiency that is present for at least three years.

How do I get a copy of my dot physical?

What happens if you get pulled over without a DOT medical card? This varies by state but can include traffic citations, fines for the driver and employer, license suspension, and immediate refusal to allow you to continue driving.

What is a MCSA 5876 certificate?

Medical certificates are sometimes required to obtain certain health benefits from an employer, to make an insurance claim, for tax purposes, or for certain legal procedures. Medical certificates are used to indicate eligibility of activity, such as the use of disabled parking.