DOT Medical Exam: The Complete Guide

Complying with DOT background check regulations and requirements is essential when hiring for regulated commercial driver positions. One aspect of compliance is ensuring that your drivers have undergone DOT physicals and hold valid DOT medical cards. Read on to learn more about DOT physical exams.

A DOT medical exam is a comprehensive physical exam performed by a licensed medical examiner listed on the Federal Motor Carrier Safety Administration (FMCSA) National Registry (the DOT agency responsible for regulating commercial motor vehicles). The purpose of a DOT physical is to ensure that prospective commercial drivers meet the occupational health standards necessary to operate a commercial motor vehicle safely. DOT medical exams are a part of a DOT background check, a set of screenings that employers must perform before hiring a CDL driver for a regulated commercial driving position.

Generally, any CDL driver in the US who operates a commercial vehicle across state lines needs a DOT physical exam. The DOT physical is typically a requirement for any interstate CDL driver who operates one of the following vehicles:

States may also require CDL drivers to undergo a DOT physical examination if they operate any of the above and other commercial vehicles within state lines. Consult your legal counsel if you’re unsure whether DOT physicals are mandatory for your commercial driving positions.

A DOT physical exam includes a medical history review, physical examination, vision test, hearing test, blood pressure and pulse check, sleep apnea evaluation, and urine test. Here’s a look at each of these occupational health screenings included in the DOT medical exam:

At the beginning of the DOT medical exam report is a medical history report the individual is responsible for completing. It asks the individual to answer “yes,” “no,” or “not sure” to 32 different health questions. If the driver answers “yes” or “not sure” to any questions, they must provide a written explanation on the form. During the physical exam, the medical examiner will review the medical history section and ask follow-up questions as needed.

As a part of the DOT physical exam, the medical examiner will conduct a physical to examine:

• Skin
• Eyes
• Ears
• Mouth and throat
• Lungs and chest
• Abdomen
• Genitals and urinary system
• Back and spine
• Extremities and joints
• Reflexes and neurological system
• Gait
• Vascular system

Any abnormalities are recorded in the DOT medical exam form, and the medical examiner will use this information to determine if the driver has an undiagnosed medical condition that may interfere with their ability to safely operate a vehicle.

Usually performed by a licensed optometrist or ophthalmologist, the vision test ensures that a CDL driver can see the road, other vehicles, signage, and potential hazards while operating a commercial vehicle. Generally, a CDL driver will need at least 20/40 visual acuity in each eye with or without correction and a 70° field of vision in horizontal meridian measured in each eye. In addition, the medical professional will conduct a test to determine if the driver can differentiate between green, amber, and red colors. 

A hearing test determines if a commercial driver can hear adequately enough to notice sounds like other vehicles on the road, car horns, sirens from approaching motor vehicles, and noises from their vehicle that may indicate an equipment malfunction. For this portion of the DOT medical exam, the medical reviewer may perform a whisper test, which involves whispering words while standing behind the driver, or an audiometric hearing test, which requires the driver to recognize sounds at different frequencies.

Cardiovascular problems, such as heart disease and arrhythmia, can lead to sudden medical emergencies that may prove dangerous while operating a motor vehicle. The blood pressure and pulse check portions of the DOT physical are a way to screen for signs of potential cardiovascular concerns. For this portion of the medical exam, the medical reviewer will take the individual’s blood pressure and pulse and indicate if there are any irregularities in pulse rhythm.

Sleep apnea is a condition that causes a person to stop breathing repeatedly during sleep. Individuals with untreated sleep apnea may feel tired during the day, which may interfere with their ability to operate a motor vehicle safely. As a result, the DOT medical exam will ask if the individual has a sleep apnea diagnosis. If the individual does, the medical examiner may ask questions about the treatment of the condition.

Some medical conditions that may interfere with an individual's ability to safely operate a motor vehicle may cause abnormal levels of certain substances to appear in urine. The DOT physical’s urinalysis or urine testing analyzes a urine sample for specific gravity, protein, blood, and sugar.

Understanding the DOT requirements and regulations for physicals is the first step for ensuring compliance as an employer hiring for a regulated CDL driver position. Read on for an introduction to FMCSA regulations, disqualifying medications and medical conditions, and DOT drug testing requirements.

Section 391 of the FMCSA regulations establishes the medical examination requirements for CDL drivers. Under the regulations, a CDL driver operating a commercial motor vehicle across state lines must undergo a physical exam and obtain a medical certificate, commonly called a medical card. 

Unless a driver has a condition that requires more frequent assessment, the medical examiner certificate remains valid for two years. Individuals with diabetes, heart disease, high blood pressure, and other medical conditions may receive a certificate valid for one year. Before the DOT medical card expires, the driver must undergo another physical exam and receive a new certificate. To comply with this rule, employers often require candidates to obtain a new medical certificate before starting employment. 

Under FMCSA regulations, disqualifying medical conditions for CDL drivers include hearing loss, vision loss, and epilepsy. However, drivers can obtain exemptions to this regulation in some cases by submitting a request to the FMCSA for review.

Although the FMCSA regulations only name three disqualifying medical conditions, other medical conditions may also prevent a CDL driver from obtaining the DOT medical certificate necessary to operate a commercial vehicle. The regulations state that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce. As a result, a medical examiner may use their discretion and disqualify a driver with any condition that could prevent them from driving safely. For example, individuals with narcolepsy may not be able to obtain a medical certificate. 

Some medications can limit a driver’s ability to receive DOT certification. FMCSA regulations disqualify drivers who use insulin to control diabetes, unless they receive an exemption. 

Other drugs that can negatively impact a DOT certification include amphetamines, narcotics, and other habit-forming drugs. Individuals legally prescribed these drugs can use a doctor’s note stating the individual is safe to work as commercial drivers while taking these medications. Medical examiners may consider this information when determining whether to certify drivers. However, having a letter from a doctor doesn’t automatically mean that the examiner will grant certification to someone taking a habit-forming drug.

In addition to receiving medical certification, CDL drivers who operate vehicles across state lines must undergo pre-employment drug testing under DOT and FMCSA regulations. The DOT requires testing for the following five substances prior to employment:

In addition to mandating pre-employment screening, regulations mandate that employers require drug and alcohol testing whenever there is a suspicion of on-the-job intoxication, following qualified motor vehicle accidents and when drivers return to work following a suspension due to drug and alcohol use.

Learn more about DOT physicals by exploring the answers to these frequently asked questions.

The cost of a DOT physical varies based on geographic location and the individual rates charged by registered medical examiners. A medical doctor, osteopath, chiropractor, advanced practice nurse, physical therapy provider, physician’s assistant, or other registered medical examiner is free to establish their own rates, and the FMCSA has no rules regarding whether the individual or the employer is responsible for covering the costs. With Checkr, DOT physicals start at $110 per exam.

The duration of a DOT physical can vary, but most exams are completed within 30 to 45 minutes. When scheduling an appointment for a DOT physical, candidates can ask the medical examiner for a more specific time estimate.

Failing a DOT physical depends on the specific medical disqualification and the employer’s background check policy. Each organization sets its own policies for handling cases where a candidate “fails” a background check, and should proceed based on those guidelines. 

In some cases, the employer may offer the driver an alternative position that doesn’t involve operating a motor vehicle or encourage them to reapply after receiving treatment or obtaining an FMCSA medical exemption to qualify for certification. Alternatively, the candidate may be disqualified from consideration for employment altogether.

The main form needed for a DOT physical is the Medical Examination Report (MER) Form, MCSA-5875. Individuals with vision loss, hearing loss, seizures, and other medical conditions may be required to complete additional forms to request exemptions. A medical examiner will typically advise the driver when additional forms are necessary and provide them during the exam. 

The CDL DOT medical exam for DMV and FMCSA-regulated positions helps to reduce the risk of accidents by screening CDL drivers for health conditions that may impair their driving ability. As an employer, ensuring that candidates for regulated positions have a valid DOT medical exam certificate is an important part of the DOT background check process.

Checkr supports compliance with FMCSA requirements, offering comprehensive DOT background checks. With our customizable packages, you can conduct the background screenings necessary to help remain compliant, from DOT medical exams to DOT drug testing and motor vehicle records (MVR) checks and more. Our platform allows you to review the results of all screenings in one place, while a mobile-first candidate experience helps improve time-to-hire. Get started with Checkr today.

About the author

Hayley Harrison writes about a wide range of business topics and best practices, including background checks, candidate experience, and recruitment and retention. Her work includes educational articles, e-books, and blog posts.