DOT CDL commercial driver — FMCSA medical certification
dot-cdl-driver
OSHA / regulatory citation: 49 CFR 391.41 (physical qualifications) + 391.43 (medical examination) + NRCME National Registry of Certified Medical Examiners
Periodicity: 24 months (recertification required)
Key thresholds
- ●Vision: ≥20/40 each eye + binocular (corrected) · ≥70° horizontal field each eye · color recognition of red/amber/green
- ●Hearing: perceive forced-whisper at ≥5 ft, or ≤40 dB average loss (500/1000/2000 Hz) in better ear
- ●BP: <140/90 certify 2 yr · 140-159/90-99 stage 1 = 1 yr · ≥180/110 cannot certify until controlled
- ●Insulin-treated diabetes: certifiable via FMCSA ITDM assessment form (MCSA-5870)
vision
- ▸ Visual acuity each eye + binocular WITH correction worn (Snellen 20 ft)
- ▸ Visual acuity each eye + binocular WITHOUT correction (for documentation)
- ▸ Peripheral horizontal field each eye (confrontation): >=70 degrees in horizontal meridian (each eye)
- ▸ Color recognition for traffic signal colors (red, amber, green) — Ishihara or color vision test or functional recognition
- ▸ Binocular vision testing
hearing
- ▸ Forced whisper test at 5 feet (using one ear at a time, opposite ear covered, whisper from behind to prevent lip reading) OR
- ▸ Audiometric test: average hearing loss in better ear at 500, 1000, 2000 Hz must be <=40 dB
cardiovascular
- ▸ Blood pressure (systolic/diastolic) — multiple measurements if elevated
- ▸ Heart rate and rhythm (12-lead ECG NOT routine but FMCSA recommends if symptoms/history)
- ▸ Cardiac auscultation (murmurs, gallops)
- ▸ Peripheral pulses + edema
- ▸ Carotid auscultation
neurologic psychiatric
- ▸ Gait observation
- ▸ Strength testing if neurologic symptoms
- ▸ Coordination (finger-to-nose, tandem walk)
- ▸ Mental status / orientation impression
- ▸ Tremor assessment
musculoskeletal
- ▸ Range of motion neck, back, extremities
- ▸ Grip strength impression
- ▸ Ability to grasp steering wheel + manipulate pedals (functional)
- ▸ Loss of limb or function (SPE assessment)
respiratory
- ▸ Lung auscultation + breath sound quality
- ▸ Spirometry if COPD or restrictive disease history (NOT routine)
general
- ▸ Height, weight, BMI calculation (BMI >=35 — STOP-BANG triggers OSA further evaluation)
- ▸ Neck circumference (>17 in male, >16 in female — OSA risk)
- ▸ General body habitus
- ▸ Skin (jaundice, pallor, signs of substance use)
urinalysis
- ▸ Urinalysis (dipstick): protein, blood, sugar (glucosuria triggers HbA1c)
- ▸ If glucosuria, blood glucose or HbA1c follow-up
Complementary tests
- ▸ Urinalysis dipstick — Every DOT exam — protein, blood, sugar
- ▸ ECG 12-lead — Not routine; required if cardiac history, current symptoms, or anticoagulation/pacemaker
- ▸ HbA1c — If glucosuria detected, or DM on oral or insulin treatment
- ▸ Polysomnography or HSAT (Home Sleep Apnea Test) — If STOP-BANG positive OR BMI >=35 + neck circumference threshold OR symptoms; AHI >=20 untreated disqualifies
- ▸ Pulmonary function tests (spirometry) — If COPD diagnosis or severe respiratory disease
- ▸ Visual fields formal testing (Goldmann or automated perimetry) — If confrontation field abnormal or glaucoma diagnosis
- ▸ Cardiac stress test, echocardiogram, or holter monitor — Per FMCSA Cardiovascular Advisory Panel guidance for specific cardiac conditions
- ▸ Pre-employment / random / reasonable-suspicion / post-accident / return-to-duty / follow-up drug + alcohol testing — DOT drug + alcohol testing 49 CFR Part 40 — separate process from medical exam but parallel
Note: Examiner must be a Certified Medical Examiner on the FMCSA National Registry (NRCME). Exam recorded on Form MCSA-5875; certificate is the MCSA-5876 'DOT card'. Directive model: the CME certifies / denies / sets the certification period.
CFR / source ↗