VISION EVALUATION REPORT Federal Motor Carrier Safety Administration
Web Form MCSA 5871 U S Department of Transportation Federal Motor Carrier Safety Administration OMB No 2126 0006 Expiration Date Name DOB b Condition or disease Date of diagnosis Current treatment Severity Is condition stable Mild Yes Moderate No Severe If no why If no why c Condition or disease Date of diagnosis Current treatment
Form MCSA 5871 MCSA 5871 Vision Evaluation Report OMB , Web Apr 27 2023 nbsp 0183 32 OMB No 2126 0006 Expiration Date Form MCSA 5871 U S Department of Transportation Federal Motor Carrier Safety Administration A Federal agency may not conduct or sponsor and a person is not required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the
Federal Register Qualifications Of Drivers Vision Standard
Web Jan 21 2022 nbsp 0183 32 The Vision Evaluation Report Form MCSA 5871 contains the information necessary for an ME to determine whether the individual satisfies the existing vision standard using more sophisticated testing equipment or requires certification under the alternative vision standard
General Vision Exemption Package FMCSA, Web Mar 9 2022 nbsp 0183 32 Vision Package FMCSA s Vision Standard final rule is effective March 22 2022 87 FR 3390 The new alternative vision standard replaces the current vision exemption program as a basis for determining the physical qualification of drivers who cannot otherwise meet the vision standard
Federal Register Qualifications Of Drivers Vision Standard
Federal Register Qualifications Of Drivers Vision Standard, Web Jan 12 2021 nbsp 0183 32 The Vision Evaluation Report Form MCSA 5871 collects the individual s name date of birth driver s license number and State of issuance In addition the report collects the following information 1 Whether the individual completing the report is an ophthalmologist or an optometrist
Vision Evaluation Report Form MCSA 5871 Pass My Physical
Medical Qualification Requirements OMB 2126 0006
Medical Qualification Requirements OMB 2126 0006 Web Feb 25 2022 nbsp 0183 32 The need for the Federal Vision Exemption Program would be eliminated by adding a new requirement for an ophthalmologist or optometrist to complete the Vision Evaluation Report Form MCSA 5871 that would be provided to the certified ME The collection is mandatory
Dot Printable Form Printable Forms Free Online
Web Jan 26 2022 nbsp 0183 32 The ophthalmologist or optometrist completes the new Vision Evaluation Report Form MCSA 5871 The certified medical examiner performs a DOT exam not more than 45 days from the date on the MCSA 5871 and determines if the driver meets the alternative vision standard as well as FMCSA s other medical qualification standards Alternate Vision Standard Final Rule J J Keller. Web Aug 24 2021 nbsp 0183 32 In May 2021 FMCSA requested in part that FMCSA s Medical Review Board MRB review and analyze the comments from medical professionals and associations and make recommendations regarding the proposed alternative vision standard for FMCSA to consider Web 1 The medical examiner must receive a completed Vision Evaluation Report Form MCSA 5871 signed and dated by an ophthalmologist or optometrist for each required examination This Report shall be treated and retained as part of the Medical Examination Report Form MCSA 5875
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