|
6. LABORATORY AND OTHER TEST FINDINGS Numerical readings must be recorded.
|
URINE SPECIMEN
|
SP. GR. |
PROTEIN |
BLOOD |
SUGAR |
Urinalysis is required. Protein, blood or sugar in the urine may
be an indication for further testing to rule out any underlying medical
problem.
Other Testing (Describe
and record)
___________________________________________________
___________________________________________________
___________________________________________________
| 7. PHYSICAL EXAMINATION |
Height:_________ (in.) Weight:_________ (lbs.) |
Name:
Last, First,
Middle,
The presence of a certain condition may not necessarily disqualify
a driver, particularly if the condition is controlled adequately,
is not likely to worsen or is readily amenable to treatment.
Even if a condition does not disqualify a driver, the medical examiner
may consider deferring the driver temporarily. Also, the driver
should be advised to take the necessary steps to correct
the condition as soon as possible particularly if the condition,
if neglected, could result in more serious illness that might affect
driving.
Check YES if there are any abnormalities. Check NO if the body system
is normal. Discuss any YES answers in detail in the space below,
and indicate whether it would affect the driver’s ability
to operate a commercial motor vehicle safely. Enter applicable item
number before each comment. If organic disease is present, note
that it has been compensated for.
See Instructions to the Medical Examiner for
guidance.
| BODY SYSTEM |
CHECK FOR: |
YES* |
NO |
BODY SYSTEM |
CHECK FOR: |
YES* |
NO |
| 1. General Appearance |
Marked overweight, tremor, signs of alcoholism, problem
drinking, or drug abuse. |
|
|
7. Abdomen and Viscera |
Enlarged liver, enlarged spleen, masses, bruits, hernia,
significant abdominal wall muscle weakness. |
|
|
| 2. Eyes |
Pupillary equality, reaction to light, accommodation, ocular
motility, ocular muscle imbalance, extraocular movement,
nystagmus, exophthalmos, strabismus uncorrected by
corrective lenses, retinopathy, cataracts, aphakia, glaucoma,
macular degeneration and refer to a specialist if appropriate. |
|
|
8. Vascular System |
Abnormal pulse and amplitude, carotid or arterial bruits,
varicose veins. |
|
|
| 3. Ears |
Scarring
of tympanic membrane, occlusion of external canal, perforated eardrums. |
|
|
9. Genito-urinary System |
Hernias. |
|
|
| 4. Mouth and Throat |
Irremediable
deformities likely to interfere with breathing or swallowing. |
|
|
10. Extremities - Limb impaired. Driver may be subject to SPE certificate
if otherwise qualified. |
Loss or impairment of leg, foot, toe, arm, hand, finger.
Perceptible limp, deformities, atrophy, weakness, paralysis,
clubbing, edema, hypotonia. Insufficient grasp and prehension in upper limb to maintain steering wheel grip.
Insufficient mobility and strength in lower limb to operate
pedals properly. |
|
|
| 5. Heart |
Murmurs, extra sounds, enlarged heart, pacemaker, implantable defibrillator. |
|
|
11. Spine, other musculoskeletal |
Previous surgery, deformities, limitation of motion, tenderness. |
|
|
| 6. Lungs and chest, not including breast examination. |
Abnormal chest wall expansion, abnormal respiratory rate,
abnormal breath sounds including wheezes or alveolar
rales, impaired respiratory function, cyanosis. Abnormal findings on physical exam may require
further testing such as pulmonary tests and/or xray of chest. |
|
|
12. Neurological |
Impaired equilibrium, coordination or speech pattern;
asymmetric deep tendon reflexes, sensory or positional
abnormalities, abnormal patellar and Babinski’s
reflexes, ataxia. |
|
|
*COMMENTS:____________________________________________
_______________________________________________________
_______________________________________________________
Note certification status here. See Instructions
to the Medical Examiner for guidance.
|
Meets standards
in 49 CFR 391.41; qualifies for 2 year certificate
Does not meet
standards
Meets standards,
but periodic evaluation required to __________
Driver qualified only for:
3 months
1 year
6 months
Other
Temporarily
disqualified due to (condition or medication):
___________
Return to medical examiner’s office for follow up on ____________
|
Wearing corrective
lenses
Wearing hearing
aid
Accompanied
by a _________ waiver/exemption.
Driver must present exemption at time of certification.
Skill Performance
Evaluation (SPE) Certificate
Driving within
an exempt intracity zone
Qualified by
operation of 49 CFR 391.64
Medical Examiner’s Signature
Medical Examiner’s Name (print)
Address
Telephone Number
|
If meets standards, complete a Medical Examiner’s Certificate according
to 49 CFR 391.43(h). (Driver must
carry certificate when operating a commercial vehicle.)
|
49
CFR 391.41 Physical Qualifications for Drivers
THE
DRIVER’S ROLE
Responsibilities, work schedules,
physical and emotional demands, and lifestyles among commercial drivers
vary by the type of driving that they do. Some of the main types of drivers
include the following: turn around or short relay (drivers return to their
home base each evening); long relay (drivers drive 9-11 hours and then have
at least a 10-hour off-duty period), straight through haul (cross country
drivers); and team drivers (drivers share the driving by alternating their
5-hour driving periods and 5-hour rest periods.)
The following factors may be involved in a driver’s performance of duties:
abrupt schedule changes and rotating work schedules, which may result in
irregular sleep patterns and a driver beginning a trip in a fatigued condition;
long hours; extended time away from family and friends, which may result
in lack of social support; tight pickup and delivery schedules, with irregularity
in work, rest,and eating patterns, adverse road, weather and
traffic conditions, which may cause delays and lead to hurriedly loading
or unloading cargo in order to compensate for the lost time; and environmental
conditions such as excessive vibration, noise, and extremes in temperature.
Transporting passengers or hazardous materials may add to the demands on
the commercial driver.
There may be duties in addition to the driving task for which a driver is
responsible and needs to be fit. Some of these responsibilities are: coupling
and uncoupling trailer(s) from the tractor,loading and unloading
trailer(s) (sometimes a driver may lift a heavy load or unload as much as
50,000 lbs. of freight after sitting for a long period of time without any
stretching period); inspecting the operating condition of tractor and trailer(s)
before, during, and after delivery of cargo; lifting, installing, and removing
heavy tire chains; and, lifting heavy tarpaulins to cover open top trailers.
The above tasks demand agility, the ability to bend and stoop, the ability
to maintain a crouching position to inspect the underside of the vehicle,
frequent entering and exiting of the cab, and the ability to
climb ladders on the tractor and/or trailer(s).
In addition, a driver must have the perceptual skills to monitor
a sometimes complex driving situation, the judgment skills to make quick
decisions, when necessary, and the manipulative skills to control an oversize
steering wheel, shift gears using a manual transmission, and maneuver a
vehicle in crowded areas.
§391.41
PHYSICAL QUALIFICATIONS FOR DRIVERS
(a) A person shall not drive a commercial motor vehicle unless he is physically
qualified to do so and, except as provided in §391.67, has on his person
the original, or a photographic copy, of a medical examiner’s certificate
that he is physically qualified to drive a commercial motor vehicle.
(b) A person is physically qualified to drive a motor vehicle if that
person:
(1) Has no loss of a foot, a leg, a hand, or an arm, or has been granted
a Skill Performance Evaluation (SPE)Certificate (formerly Limb
Waiver Program) pursuant to§391.49.
(2) Has no impairment of: (i) A hand or finger which interferes with prehension
or power grasping; or (ii) An arm,foot, or leg which interferes
with the ability to perform normal tasks associated with operating a commercial
motor vehicle;or any other significant limb defect or limitation
which interferes with the ability to perform normal tasks associated
with operating a commercial motor vehicle; or has been granted
a SPE Certificate pursuant to §391.49.
(3) Has no established medical history or clinical diagnosis
of diabetes mellitus currently requiring insulin for control;
(4) Has no current clinical diagnosis of myocardialinfarction,
angina pectoris, coronary insufficiency, thrombosis, or any
other cardiovascular disease of a variety known to be accompanied
by syncope, dyspnea, collapse, or congestive cardiac failure.
(5) Has no established medical history or clinical
diagnosis of a respiratory dysfunction likely to interfere with his
ability to control and drive a commercial motor vehicle
safely.
(6) Has no current clinical diagnosis of high bloodpressure
likely to interfere with his ability to operate a commercial motor
vehicle safely. |
(7)
Has no established medical history or clinical diagnosis of
rheumatic, arthritic, orthopedic, muscular,neuromuscular, or
vascular disease which interferes with his ability to control
and operate a commercial motor vehicle safely.
(8) Has no established medical history or clinical diagnosis
of epilepsy or any other condition which is likely to cause
loss of consciousness or any loss of ability to control a commercial
motor vehicle;
(9) Has no mental, nervous, organic, or functional disease or psychiatric
disorder likely to interfere with his ability to drive
a commercial motor vehicle safely;
(10) Has distant visual acuity of at least 20/40(Snellen) in
each eye without corrective lenses or visual acuity separately
corrected to 20/40 (Snellen) or better with corrective lenses,
distant binocular acuity of at least 20/40(Snellen) in both
eyes with or without corrective lenses, field of vision of
at least 70 degrees in the horizontal meridian in each eye,
and the ability to recognize the colors of traffic signals
and devices showing standard red, green and amber;
(11) First perceives a forced whispered voice in the better
ear not less than 5 feet with or without the use of a hearing
aid, or, if tested by use of an audiometric device,does
not have an average hearing loss in the better ear greater
than 40 decibels at 500 Hz, 1,000 Hz and 2,000 Hz with or without
a hearing aid when the audiometric device is calibrated
to American National Standard (formerly ASA Standard) Z24.5-1951;
(12) (i) Does not use a controlled substance identified in
21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or
any other habit-forming drug. (ii) Exception: A driver may use such
a substance or drug, if the substance or drug is prescribed
by a licensed medical practitioner who: (A) Is familiar
with the driver’s medical history and assigned duties;
and (B) Has advised the driver that the prescribed substance |
or drug
will not adversely affect the driver’s ability to safely
operate a commercial motor vehicle; and (13) Has no current
clinical diagnosis of alcoholism. |
INSTRUCTIONS
TO THE MEDICAL EXAMINER
General
Information The
purpose of this examination is to determine a driver’s physical
qualification to operate a commercial motor vehicle(CMV)
in interstate commerce according to the requirements in49
CFR 391.41-49. Therefore, the medical examiner must be knowledgeable
of these requirements and guidelines developed by the FMCSA
to assist the medical examiner in making the qualification
determination. The medical examiner should be familiar
with the driver’s responsibilities and work environment
and is referred to the section on the form, The Driver’s Role.
In addition to reviewing the Health History section
with the driver and conducting the physical examination,
the medical examiner should discuss common prescriptions
and over-the counter medications relative to the side effects
and hazards of these medications while driving. Educate
driver to read warning labels on all medications. History
of certain conditions may because for rejection, particularly
if required by regulation, or may indicate the need for
additional laboratory tests or more stringent examination
perhaps by a medical specialist. These decisions are usually
made by the medical examiner in light of the driver’s job
responsibilities, work schedule and potential for the condition to
render the driver unsafe.
Medical conditions should be recorded even if they are
not cause for denial, and they should be discussed with
the driver to encourage appropriate remedial care. This advice is
especially needed when a condition, if neglected, could
develop into a serious illness that could affect driving.
If the medical examiner determines that the driver is fit
to drive and is also able to perform non-driving responsibilities
as may be required, the medical examiner signs the medical
certificate which the driver must carry with his/her license. The
certificate must be dated. Under current regulations,
the certificate is valid for two years, unless the driver
has a medical condition that does not prohibit driving
but does require more frequent monitoring. In
such situations, the medical certificate should be issued
for a shorter length of time. The physical examination
should be done carefully and at least as complete as is
indicated by the attached form. Contact the FMCSA at(202)
366-1790 for further information (a vision exemption, qualifying
drivers under 49 CFR 391.64, etc.)
.
Interpretation
of Medical Standards Since
the issuance of the regulations for physical qualifications of commercial
drivers, the Federal Motor Carrier Safety Administration (FMCSA) has
published recommendations called Advisory Criteria to help medical
examiners in determining whether a driver meets the physical qualifications
for commercial driving. These recommendations have been condensed
to provide information to medical examiners that (1) is directly relevant
to the physical examination and (2) is not already included in the
medical examination form. The specific regulation is printed in italics
and its reference by section is highlighted. |
Federal
Motor Carrier Safety Regulations- Advisory Criteria
Loss
of Limb:
§391.41(b)(1)
A person is physically qualified to drive a
commercial motor vehicle if that person:Has
no loss of a foot, leg, hand or an arm, or has been granted
a Skill Performance Evaluation (SPE) Certificate pursuant
to Section 391.49.
Limb
Impairment:
§391.41(b)(2)
A person is physically qualified to drive a
commercial motor vehicle if that person:Has
no impairment of: (i) A hand or finger which interferes with
prehension or power grasping; or (ii) An arm, foot, or leg
which interferes with the ability to perform normal tasks
associated with operating a commercial motor vehicle; or (iii)Any
other significant limb defect or limitation which interferes
with the ability to perform normal tasks associated with
operating a commercial motor vehicle; or (iv)
Has been granted a Skill Performance Evaluation Certificate
pursuant to Section 391.49.
A person who suffers loss
of a foot, leg, hand or arm or whose limb impairment in any way
interferes with the safe performance of normal tasks
associated with operating a commercial motor vehicle
is subject to the Skill Performance Evaluation (SPE)
Certification Program pursuant to section391.49, assuming
the person is otherwise qualified.
With the advancement
of technology, medical aids and equipment modifications
have been developed to compensate for certain disabilities.
The SPE Certification Program (formerly the Limb Waiver Program)
was designed to allow persons with the loss of a foot
or limb or with functional impairment to qualify under
the Federal Motor Carrier Safety Regulations (FMCSRs)
by use of prosthetic devices or equipment modifications
which enable them to safely operate a commercial motor vehicle.
Since there are no medical aids equivalent to the original
body or limb,certain risks are still present, and thus
restrictions may be included on individual SPE certificates
when a State Director for the FMCSA determines they are necessary
to be consistent with safety and public interest.
If the driver
is found otherwise medically qualified (391.41(b)(3)
through (13)), the medical examiner must check on the
medical certificate that the driver is qualified only if
accompanied by a SPE certificate. The driver and the employing
motor carrier are subject to appropriate penalty if the driver operates
a motor vehicle in interstate or foreign commerce without
a current SPE certificate for his/her physical disability.
|
Diabetes
§391.41(b)(3)
A person is physically qualified to drive a
commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of diabetes
mellitus currently requiring insulin for control.
Diabetes mellitus is a disease
which, on occasion, can result in a loss of consciousness or disorientation
in time and space. Individuals who require insulin for
control have conditions which can get out of control by the use
of too much or too little insulin, or food intake not
consistent with the insulin dosage. Incapacitation may
occur from symptoms of hyperglycemic or hypoglycemic
reactions (drowsiness,semi consciousness, diabetic coma
or insulin shock).
The administration
of insulin is, within itself, a complicated process requiring
insulin, syringe, needle, alcohol sponge and a sterile
technique. Factors related to long-haul commercial motor
vehicle operations, such as fatigue, lack of sleep, poor diet, emotional
conditions, stress, and concomitant illness, compound
the diabetic problem. Thus, because of these inherent
dangers, the FMCSA has consistently held that a diabetic
who uses insulin for control does not meet the minimum
physical requirements of the FMCSRs.
Hypoglycemic
drugs, taken orally, are sometimes prescribed for diabetic individuals
to help stimulate natural body production of insulin. If the condition
can be controlled by the use of oral medication and diet, then an
individual may be qualified under the present rule. CMV drivers
who do not meet the Federal diabetes standard may call (202) 366-1790
for an application for a diabetes exemption.
(See Conference Report on Diabetic Disorders and Commercial Drivers
and Insulin-Using Commercial Motor Vehicle Drivers at::http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
Cardiovascular
Condition
§391.41(b)(4)
A person is physically qualified to
drive a commercial motor vehicle if that person:
Has no current clinical diagnosis of myocardial infarction,angina
pectoris, coronary insufficiency, thrombosis or any other
cardiovascular disease of a variety known to be accompanied
by syncope, dyspnea, collapse or congestive cardiac failure.
The term “has
no current clinical diagnosis of” is specifically designed
to encompass: “a clinical diagnosis of”(1)
a current cardiovascular condition, or (2) a cardiovascular condition
which has not fully stabilized regardless of the time limit.
The term “known to be accompanied by” is
defined to include: a clinical diagnosis of a cardiovascular
disease (1) which is accompanied by symptoms of syncope, dyspnea,
collapse or congestive cardiac failure; and/or (2) which is
likely to cause syncope, dyspnea, collapse or congestive
cardiac failure.
|
|
Continuation
of Cardiovascular
Condition
§391.41(b)(4)
It is
the intent of the FMCSRs to render unqualified, a driver
who has a current cardiovascular disease which is accompanied
by and/or likely to cause symptoms of syncope, dyspnea,
collapse, or congestive cardiac failure. However, the subjective
decision of whether the nature and severity of an individual’s
condition will likely cause symptoms of cardiovascular
insufficiency is on an individual basis and qualification
rests with the medical examiner and the motor carrier.
In those cases where there is an occurrence of cardiovascular
insufficiency (myocardial infarction,thrombosis, etc.),
it is suggested before a driver is certified that he or
she have a normal resting and stress electrocardiogram
(ECG), no residual complications and no physical limitations, and
is taking no medication likely to interfere with safe
driving. Coronary
artery bypass surgery and pacemaker implantation are
remedial procedures and thus, not unqualifying. Coumadin
is a medical treatment which can improve the health and safety of
the driver and should not, by its use, medically disqualify
the commercial driver. The emphasis should be on the
underlying medical condition(s) which require treatment
and the general health of the driver.The FMCSA should
be contacted at (202) 366-1790 for additional recommendations
regarding the physical qualification of drivers on coumadin.See
Conference on Cardiac Disorders and Commercial Drivers at:http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
Respiratory
Dysfunction
§391.41(b)(5)
A person is physically qualified to drive a commercial motor vehicle
if that person:
Has no established medical history or clinical diagnosis of a respiratory
dysfunction likely to interfere with ability to control
and drive a commercial motor vehicle safely.
Since a driver must be alert at all times, any change in his or
her mental state is in direct conflict with highway safety. Even
the slightest impairment in respiratory function under emergency
conditions (when greater oxygen supply is necessary for performance)
may be detrimental to safe driving.
There are many conditions that interfere with oxygen exchange and
may result in incapacitation, including emphysema, chronic asthma,
carcinoma, tuberculosis, chronic bronchitis and sleep apnea. If
the medical examiner detects a respiratory dysfunction, that in
any way is likely to interfere with the driver's ability to safely
control and drive a commercial motor vehicle, the driver must be
referred to a specialist for further evaluation and therapy. Anticoagulation
therapy for deep vein thrombosis and/or pulmonary thromboembolism
is not unqualifying once optimum dose is achieved, provided lower
extremity venous examinations remain normal and the treating physician
gives a favorable recommendation. (See Conference on Pulmonary/Respiratory
Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
|
Hypertension
§391.41(b)(6)
A person is
physically qualified to drive a commercial motor vehicle if that
person: Has no current clinical diagnosis of high blood pressure
likely to interfere with ability to operate a commercial motor vehicle
safely.
Hypertension alone is unlikely to cause sudden collapse; however,
the likelihood increases when target organ damage, particularly
cerebral vascular disease, is present. This regulatory criteria
is based on FMCSA's Cardiovascular Advisory Guidelines for the Examination
of CMV Drivers, which used the Sixth Report of the Joint National
Committee on Detection, Evaluation, and Treatment of High Blood
Pressure (1997).
Stage 1 hypertension
corresponds to a systolic BP of 140-159 mmHg and/or a diastolic
BP of 90-99 mmHg. The driver with a BP in this range is at low risk
for hypertension-related acute incapacitation and may be medically
certified to drive for a one-year period. Certification examinations
should be done annually thereafter and should be at or less than
140/90. If less than 160/100, certification may be extended one
time for 3 months.
A blood pressure of 160-179 systolic and/or 100-109 diastolic is
considered Stage 2 hypertension, and the driver is not necessarily
unqualified during evaluation and institution of treatment. The
driver is given a one time certification of three months to reduce
his or her blood pressure to less than or equal to 140/90. A blood
pressure in this range is an absolute indication for anti-hypertensive
drug therapy. Provided treatment is well tolerated and the driver
demonstrates a BP value of 140/90 or less, he or she may be certified
for one year from date of the initial exam. The driver is certified
annually thereafter.
A blood pressure
at or greater than 180 (systolic) and 110 (diastolic) is considered
Stage 3, high risk for an acute BP-related event. The driver may
not be qualified, even temporarily, until reduced to 140/90 or less
and treatment is well tolerated. The driver may be certified for
6 months and biannually (every 6 months) thereafter if at recheck
BP is 140/90 or less.
Annual recertification is recommended if the medical examiner does
not know the severity of hypertension prior to treatment.
An elevated blood pressure finding should be confirmed by at least
two subsequent measurements on different days.
Treatment includes nonpharmacologic and pharmacologic modalities
as well as counseling to reduce other risk factors. Most antihypertensive
medications also have side effects, the importance of which must
be judged on an individual basis. Individuals must be alerted to
the hazards of these medications while driving. Side effects of
somnolence or syncope are particulary undesirable in commercial
drivers.
Secondary hypertension
is based on the above stages.
Evaluation is warranted if patient is persistently hypertensive
on maximal or near-maximal doses of 2-3 pharmacologic agents. Some
causes of secondary hypertension may be amenable to surgical intervention
or specific pharmacologic disease.
(See Cardiovascular Advisory Panel Guidelines for the Medical Examination
of Commercial Motor Vehicle Drivers at:
http://www.fmcsa.dot.gov/rulesregs/medreports.htm
|
Rheumatic,
Arthritic, Orthopedic, Muscular,Neuromuscular or Vascular
Disease
§391.41(b)(7)
A person is physically qualified to drive a commercial motor vehicle
if that person:
Has no established medical history or clinical diagnosis of
rheumatic, arthritic, orthopedic, muscular, neuromuscular or
vascular disease which interferes with ability to control and
operate a commercial motor vehicle safely.
Certain diseases are known to have acute episodes of transient
muscle weakness, poor muscular coordination (ataxia), abnormal
sensations (paresthesia), decreased muscular tone (hypotonia),
visual disturbances and pain which may be suddenly incapacitating.
With each recurring episode, these symptoms may become
more pronounced and remain for longer periods of time.
Other diseases have more insidious onsets and display symptoms
of muscle wasting (atrophy), swelling and paresthesia which
may not suddenly incapacitate a person but may restrict
his/her movements and eventually interfere with the ability
to safely operate a motor vehicle. In many instances these
diseases are degenerative in nature or may result in deterioration
of the involved area.
Once the individual
has been diagnosed as having a rheumatic, arthritic, orthopedic,
muscular, neuromuscular or vascular disease, then he/she has an
established history of that disease. The physician, when
examining an individual, should consider the following:
(1) the nature and severity of the individual’s condition (such
as sensory loss or loss of strength); (2) the degree
of limitation present (such as range of motion); (3) the likelihood
of progressive limitation (not always present initially
but may manifest itself over time); and (4) the likelihood
of sudden incapacitation. If severe functional impairment
exists, the driver does not qualify. In cases where more
frequent monitoring is required, a certificate for a
shorter time period may be issued. (See Conference on
Neurological Disorders and Commercial Drivers at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
|
|
Epilepsy
§391.41(b)(8)
A person is physically qualified to drive
a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of
epilepsy or any other condition which is likely to cause loss of
consciousness or any loss of ability to control a motor
vehicle.
Epilepsy is a chronic functional disease characterized by
seizures or episodes that occur without warning, resulting in
loss of voluntary control which may lead to loss of consciousness
and/or seizures. Therefore, the following drivers cannot
be qualified: (1) a driver who has a medical history
of epilepsy; (2) a driver who has a current clinical diagnosis of
epilepsy; or (3) a driver who is taking antiseizure medication.
If an individual has had a sudden episode of a nonepileptic
seizure or loss of consciousness of unknown cause which
did not require antiseizure medication, the decision
as to whether that person’s condition will likely cause
loss of consciousness or loss of ability to control a motor
vehicle is made on an individual basis by the medicalexaminer
in consultation with the treating physician. Before certification
is considered, it is suggested that a 6-month waiting
period elapse from the time of the episode. Following the
waiting period, it is suggested that the individual have a complete
neurological examination. If the results of the examination
are negative and antiseizure medication is not required,
then the driver may be qualified.
In those individual cases where a driver has a seizure or an
episode of loss of consciousness that resulted from a
known medical condition (e.g., drug reaction, high temperature,
acute infectious disease, dehydration or acutemetabolic
disturbance), certification should be deferred until the
driver has fully recovered from that condition and has no existing
residual complications, and not taking antiseizure medication.
Drivers with
a history of epilepsy/seizures off antiseizure medication and seizure-free
for 10 years may be qualified to drive a CMV in interstate commerce.
Interstate drivers with a history of a single unprovoked seizure
may be qualified to drive a CMV in interstate commerce if seizure-free
and off antiseizure medication for a 5-year period or more.
(See Conference on Neurological Disorders and Commercial Drivers
at:http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
|
Mental
Disorders
§391.41(b)(9)
A person is physically
qualified to drive a commercial motor vehicle if that person:
Has no mental, nervous, organic or functional disease or psychiatric
disorder likely to interfere with ability to drive a motor vehicle
safely.
Emotional or adjustment problems contribute directly to an individual’s
level of memory, reasoning, attention and judgment. These
problems often underlie physical disorders. A variety of
functional disorders can cause drowsiness, dizziness, confusion,
weakness or paralysis that may lead to incoordination, inattention,
loss of functional control and susceptibility to accidents
while driving. Physical fatigue,headache, impaired coordination,
recurring physical ailments and chronic “nagging” pain
may be present to such a degree that certification for
commercial driving is inadvisable. Somatic and psychosomatic
complaints should be thoroughly examined when determining
an individual’s overall fitness to drive. Disorders of
a periodically incapacitating nature, even in the early stages of
development, may warrant disqualification.
Many bus and
truck drivers have documented that “nervous trouble” related to
neurotic, personality, emotional or adjustment problems
is responsible for a significant fraction of their preventable
accidents. The degree to which an individual is able
to appreciate, evaluate and adequately respond to environmental
strain and emotional stress is critical when assessing
an individual’s mental alertness and flexibility to cope
with the stresses of commercial motor vehicle driving.
When examining the driver, it should be kept in mind that
individuals who live under chronic emotional upsets may have
deeply ingrained maladaptive or erratic behavior patterns.
Excessively antagonistic, instinctive, impulsive, openly
aggressive, paranoid or severely depressed behavior greatly
interfere with the driver’s ability to drive safely. Those individuals
who are highly susceptible to frequent states of emotional
instability (schizophrenia, affective psychoses, paranoia,
anxiety or depressive neuroses) may warrant disqualification.
Careful consideration should be given to the side effects
and interactions of medications in the overall qualification
determination. See Psychiatric Conference Report for specific recommendations
on the use of these medications and potential hazards
for driving.
(See Conference on Psychiatric Disorders and Commercial Drivers
at:
http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
|
Vision
§391.41(b)(10)
A person is physically
qualified to drive a commercial motor vehicle if that
person:
Has
distant visual acuity of at least 20/40 (Snellen) in each
eye with or without corrective lenses or visual acuity
separately corrected to 20/40 (Snellen) or better with
corrective lenses, distant binocular acuity of at least 20/40
(Snellen) in both eyes with or without corrective lenses, field of
vision of at least 70 degrees in the horizontal meridian in each
eye, and the ability to recognize the colors of traffic signals and
devices showing standard red, green, and amber.
The term “ability to recognize the colors of” is interpreted
to mean if a person can recognize and distinguish among
traffic control signals and devices showing standard red,
green and amber, he or she meets the minimum standard,
even though he or she may have some type of color perception
deficiency. If certain color perception tests are administered,
(such as Ishihara, Pseudoisochromatic, Yarn) and doubtful
findings are discovered, a controlled test using signal
red, green and amber may be employed to determine the driver’s
ability to recognize these colors.
Contact lenses are permissible if there is sufficient evidence
to indicate that the driver has good tolerance and is well
adapted to their use. Use of a contact lens in one eye
for distance visual acuity and another lens in the other eye for near
vision is not acceptable, nor telescopic lenses acceptable
for the driving of commercial motor vehicles.
If an individual meets the criteria by the use of glasses or contact
lenses, the following statement shall appear on the Medical Examiner’s
Certificate: “Qualified only if wearing corrective lenses.”
CMV drivers
who do not meet the Federal vision standard may call (202) 366-1790
for an application for a vision exemption.
(See Visual
Disorders and Commercial Drivers at:
http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
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§391.41(b)(11)
A person is
physically qualified to drive a commercial motor vehicle
if that person:
First
perceives a forced whispered voice in the better ear at not
less than 5 feet with or without the use of a hearing aid, or,
if tested by use of an audiometric device, does not have an
average hearing loss in the better ear greater than 40
decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a
hearing aid when the audiometric device is calibrated to
American National Standard (formerly ASA Standard) Z24.5-1951.
Since the prescribed standard under the FMCSRs is the American
Standards Association (ANSI), it may be necessary to convert
the audiometric results from the ISO standard to the ANSI
standard. Instructions are included on the Medical Examination
report form. If
an individual meets the criteria by using a hearing aid,
the driver must wear that hearing aid and have it in operation
at all times while driving. Also, the driver must be in
possession of a spare power source for the hearing aid.
For the whispered
voice test, the individual should be stationed at least
5 feet from the examiner with the ear being tested turned
toward the examiner. The other ear is covered. Using
the breath which remains after a normal expiration, the
examiner whispers words or random numbers such as 66,
18, 23, etc. The examiner should not use only sibilants (sounding
test materials). The opposite ear should be tested in
the same manner. If the individual fails the whispered
voice test, the audiometric test should be administered.
If an individual
meets the criteria by the use of a hearing aid, the following
statement must appear on the Medical Examiner’s Certificate
“Qualified only when wearing a hearing aid.”
(See Hearing
Disorders and Commercial Motor Vehicle Drivers at:
http://www.fmcsa.dot.gov/rulesregs/medreports.htm
Drug
Use
§391.41(b)(12)
A person is
physically qualified to drive a commercial motor vehicle
if that person:
Does
not use a controlled substance identified in 21 CFR
1308.ll.
Schedule I, an amphetamine, a narcotic, or any
other
habit-forming drug. Exception: A driver may use such
a
substance or drug, if the substance or drug is prescribed
by
a licensed medical practitioner who is familiar with the
driver’s
medical history and assigned duties; and has
advised
the driver that the prescribed substance or drug will
not
adversely affect the driver’s ability to safely operate a
commercial motor vehicle.
This exception
does not apply to methadone. The intent of the medical
certification process is to medically evaluate a driver
to ensure that the driver has no medical condition which
interferes with the safe performance of driving tasks on
a public road. If a driver uses a Schedule I drug or other
substance, an amphetamine, a narcotic, or any other habit forming
drug, it may be cause for the driver to be found medically
unqualified. Motor carriers are encouraged to obtain
a practitioner’s written statement about the effects on
transportation safety of the use of a particular drug.
A test for
controlled substances is not required as part of this
biennial certification process. The FMCSA or the driver’s
employer should be contacted directly for information on
controlled substances and alcohol testing under Part 382 of
the FMCSRs.
The term “uses”
is designed to encompass instances of prohibited drug
use determined by a physician through established medical
means. This may or may not involve body fluid testing.
If body fluid testing takes place, positive test results
should be confirmed by a second test of greater specificity.
The term “habit-forming” is intended to include any drug
or medication generally recognized as capable of becoming
habitual, and which may impair the user’s ability to
operate
a commercial motor vehicle safely.
The driver
is medically unqualified for the duration of the prohibited drug(s)
use and until a second examination shows the driver is free from
the prohibited drug(s) use. Recertification may involve a substance
abuse evaluation, the successful completion of a drug
rehabilitation program, and a negative
drug test result. Additionally, given that the certification
period is normally two years, the examiner has the
option to certify for a period of less than 2 years if this
examiner
determines more frequent monitoring is required.
(See Conference
on Neurological Disorders and Commercial Drivers and
Conference on Psychiatric Disorders and Commercial Drivers
at: http://www.fmcsa.dot.gov/rulesregs/medreports.htm)
Alcoholism
§391.41(b)(13)
A person is
physically qualified to drive a commercial motor vehicle
if that person: Has
no current clinical diagnosis of alcoholism.
The term “current
clinical diagnosis of” is specifically designed
to encompass a current alcoholic illness or those instances
where the individual’s physical condition has not fully
stabilized, regardless of the time element. If an individual
shows signs of having an alcohol-use problem, he or
she should be referred to a specialist. After counseling
and/or treatment, he or she may be considered for certification.
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