TR-40-04C
TO: Transportation Directors/Supervisors
FROM: Bruce D. Little, Senior Transportation Consultant, 303.866.6655
Shelly A. Galloway, Transportation Consultant, 303.866.6656
DATE: August 5, 2004
SUBJECT: US DOT Revised Medical Examination Report
Enclosure:
Sample US DOT Revised Medical Examination Report
Sample US DOT Medical Examiner’s Certificate
According to the Federal Motor Carrier Safety Administration (FMCSA), after September 30, 2004, all new DOT physicals must be documented on the revised Medical Examination Report.
Enclosed is a sample of the US DOT revised Medical Examination Report and the Medical Examiner’s Certificate from the Colorado State Patrol. You may download the form off their website at http://csp.state.co.us/mcsp/forms.htm. You may use the enclosed sample form, purchase similar forms from suppliers, or use the new forms from your doctor’s office, if available.
The new revisions include expanding the Guidelines for Blood Pressure Evaluation by adding three categories. Although the blood pressure readings are guidelines only, if numeric readings exceed 140/90, for instance, you should refer to the chart in section five of the Medical Examination Report to confirm the recommended expiration date of the driver’s Medical Exam Certificate for that particular blood pressure reading. Further, you should check the last page of the report to verify the doctor noted the certification status of the driver. If the certification status does not match the recommendation on the chart in section five, you should contact the doctor for clarification.
Remember, CCR 301-26, Operation of School Transportation Vehicles, requires “The physical exam report shall be on file in the driver qualification file” (4204-R-205.03). You need only have the three page report on file, not the additional seven pages of doctor’s guidelines.
Before placing the Medical Examination Report in the driver qualification file, check that all areas on the report have been completed. Also verify that the expiration dates on both the physical and the Medical Examiner’s Certificate are correct.
This letter should be placed in Section C of the Colorado School Transportation Administrator’s Reference Manual. Please mark off TR 40 on the checklist page at the front of the manual. With these changes, please remove TR-23-01C.