Outline
The Florida Department of Transportation (FDOT) Medical Examination Report is a critical document designed to assess the health and fitness of bus transit system drivers. This form is essential for ensuring that drivers meet the necessary physical qualifications to operate a bus safely. It requires the driver to provide personal information, including their name, date of birth, and driver’s license details. The form also includes a comprehensive health history section where drivers must disclose any past or present medical conditions, such as heart disease, respiratory issues, or neurological disorders. Medical examiners are tasked with evaluating this information and conducting tests on vision, hearing, blood pressure, and other health indicators. The results of these evaluations determine whether the driver meets the required standards for safe operation of a bus. Additionally, the form outlines the process for certifying drivers, including the duration of their medical clearance, which can vary based on their health status. Overall, the Florida DOT Medical form plays a vital role in maintaining safety on the roads by ensuring that only qualified individuals are behind the wheel of public transit vehicles.
Sample - Florida Dot Medical Form
Rule 14-90.0041, F.A.C.
FLORIDA DEPARTMENT OF TRANSPORTATION
MEDICAL EXAMINATION REPORT FOR BUS TRANSIT SYSTEM DRIVER
725-030-11
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05/09
1. DRIVER’S INFORMATION
Driver completes this section.
Driver’s Name (Last, First, Middle)
Birthdate
/ /
MM/DD/YY
Age
Sex
M
F
Preemployment
Biennial
Follow Up
Return to Duty
Date of Exam
/ /
Address
City, State, Zip Code
Work Tel: ( ) -
Home Tel: ( ) -
Driver License No.
License Class
A B C D Other
Date Issued
/ /
2. HEALTH HISTORY
Driver completes this section indicating any below described illness, medical condition, or injury that currently
exists or has occurred. The medical examiner is encouraged to discuss with driver.
YES NO
Head/Brain injuries, disorders or illness
Seizures, epilepsy
medication
Eye disorders or impaired vision (except
corrective lenses)
Ear disorders, loss of hearing or balance
Heart disease or heart attack; other
cardiovascular condition
medication
Heart surgery (valve replacement/by pass,
angioplasty, pacemaker)
High blood pressure
medication
YES NO
Muscular disease
Shortness of breath
Lung disease, emphysema, asthma, chronic
bronchitis
Kidney disease, dialysis
Liver disease
Digestive problems
Diabetes or elevated blood sugar controlled by:
diet
pills
insulin
Nervous or psychiatric disorders, e.g., severe
depression
medication
YES NO
Loss of, or altered consciousness
Fainting, dizziness
Sleep disorders, pauses in
breathing while asleep, daytime
sleepiness, loud snoring
Stoke or paralysis
Missing or impaired hand, arm,
foot, leg, finger, toe
Spinal injury or disease
Chronic low back pain
Regular, frequent alcohol use
Narcotic or habit forming drug
use
Any illness or injury not
described by this section
For any YES answer, indicate onset date, diagnosis, treating physician’s name and address, and any current limitation. List all medications (including over-the
counter medications) used regularly or recently.
I certify that the above information is complete and true. I understand that inaccurate, false or missing information may invalidate the examination and qualification by
the Medical Examiner.
______________________________________ / /
Driver’s Signature Date
Medical Examiners Comments on Health History (The medical examiner must review and discuss with the driver any “yes” answers and potential hazards of
medications, including over-the-counter medications, while driving.)
TESTING (Medical Examiner completes Section 3 through 7)
3. VISION Standard. A person is qualified if that person meets the vision standard established by the State of Florida for a Class A, B, C, or D
driver license, as applicable. The use of corrective lenses should be noted by the Medical Examiner.
INSTRUCTIONS: When other than the Snellen chart is used, give test results in Snellen-comparable values. In recording distance vision, use 20 feet as normal.
Report visual acuity as a ratio with 20 as numerator and the smallest type read at 20 feet as denominator. If the applicant wears corrective lenses, these should be worn
while visual acuity is being tested. If the driver habitually wears contact lenses, or intends to do so while driving, sufficient evidence of good tolerance and adaptation
to their use must be obvious.
Numerical readings must be provided.
ACUITY UNCORRECTED CORRECTED
Applicant can recognize and distinguish among traffic control signals and devices showing standard
red, green, and amber colors?
Yes No
Applicant meets visual acuity requirement only when wearing: Corrective Lenses
Monocular Vision: Yes No
Right Eye 20/ 20/
Left Eye 20/ 20/
Both Eyes 20/ 20/
Complete next line only if vision testing is done by an Ophthalmologist or Optometrist
/ /
Date of Examination Name of Ophthalmologist or Optometrist (print) Tel No. License No./State of Issue Signature
4.
HEARING Standard: a) Must first perceive forced whispered voice > 5ft., with or without hearing aid, or b) average hearing
loss in better ear < 40dB
Check if hearing aid used for tests. Check if hearing aid required to meet standard.
INSTRUCTIONS: To convert audiometric test results from ISO to ANSI, -14 dB from ISO fro 500 Hz, -8.5 dB for 2,000 Hz. To average, add the readings for 3
frequencies tested and divide by 3.
Numerical readings must be recorded.
a) Record distance from
individual at which
forced whispered voice
can first be heard.
Right Ear
Feet
Left Ear
Feet
b) If audiometer is used,
record hearing loss in decibels.
(acc. To ANSI Z24.5-1951)
Right Ear Left Ear
500 Hz
1000 Hz
2000 Hz
500 Hz
1000 Hz
2000 Hz
Average: Average:
Rule 14-90.0041, F.A.C. 725-030-11
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5.
BLOOD PRESSURE EVALUATION / PULSE RATE Numerical readings must be recorded.
Blood
Pressure
Systolic
Diastolic
Driver qualified if < 160/90
on initial exam.
Pulse
Rate
Regular
Irregular
On initial exam Within 3 months Certify
If 161 – 180 and/or 91 – 104. qualify 3 mos. only. ___._
If <
160 and/or 90, qualify for 1 yr. Document Rx &
control the 3
rd
month
___._
Annually if acceptable BP is
maintained
If > 180 and/or 104, not qualified until reduced to <
181/105. Then qualify for 3 mos. only.
___._
If <
160 and/or 90, qualify for 6 mos. Document Rx &
control the 3
rd
month
___._
Biannually
Medical examiner should take at least 2 readings to confirm blood pressure.
6. LABORATORY AND OTHER TEST FINDINGS Numerical readings must be recorded.
Urinalysis is required. Protein, blood or sugar in the urine may be an
indication for further testing to rule out any underlying medical problem. URINE SPECIMEN
SP.GR.
PROTEIN
BLOOD
SUGAR
Diabetes. Pre-employment Medical Examination: If, during a pre-employment examination, it is noted that a driver applicant has a medical history or clinical
diagnosis of diabetes mellitus requiring insulin for control, the person shall not be qualified to drive a bus. Biennial Medical Examination:
If diabetes is noted for an
existing driver at the time of his or her examination, excluding pre-employment, and the diabetic condition is stabilized or controlled by insulin, oral medication and/or
diet that can be obtained while the driver is on duty, then the driver may be qualified. Notwithstanding, the driver must remain under medical supervision as determined
by the medical examiner. Other Testing (Describe and record)
7.
PHYSICAL EXAMINATION Height: (in.) Weight: (lbs.)
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 bus 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 Pupiltary equality, reaction to light, accommodation,
ocular motility, ocular muscle imbalance, extraocular
movement, nystagmus, exophthalmos, strabismus
uncorrected by corrective lenses, retinopathy,
calaracis, aphakia, glaucoma, macular degeneration.
8. Vascular
system
Abnormal pulse and amplitude, carotid or arterial
bruits, varicose veins.
3. Ears Middle ear disease, 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
Loss of 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.
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
rates, abnormal breath sounds including wheezes or
alveolar rates, impaired respiratory function, dyspnea,
cyanosis. Abnormal findings on physical exam may
require further testing such as pulmonary tests and/or
xray of chest.
12. Neurological Impaired equilbrium, coordination or speech pattern;
paresthesia, asymmetric deep tendon reflexes, sensory
or positional abnormalities, adnormal patellar and
Babinski’s reflexes, ataxia.
COMMENTS:
Note certification status here and on the Medical Examination Certificate. See Instructions to the Medical Examiner and qualification criteria
for guidance.
Meets standards (Re-examine in 2 years) Wearing corrective lenses
Does not meet standards Wearing hearing aid
Meets standards, but periodic evaluation required.
Due to _________________________________ driver qualified only for:
3 months 6 months 1 year Other
Temporarily disqualified due to (condition or medication):
Return to medical examiner’s office for follow up on:
Please provide a completed Medical Examination Certificate to
the driver’s employer in accordance with 14-90.0041.
Driver may request a copy of his/her completed Medical
Examination Report from the medical examiner.
Medical Examiner’s Signature: _______________________________________________
Medical Examiner’s Name (print): ____________________________________________
MD DO Physician Assistant Advanced Registered Nurse Practitioner
Address: _________________________________________________________________
Telephone Number: _________________________________________________________
Rule 14-90.0041, F.A.C. 725-030-11
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05/09
MEDICAL EXAMINATION CERTIFICATE
for Bus Transit System Driver
I certify that I have examined in accordance with the requirements in Rule 14-90.0041,
Florida Administrative Code, and referenced FDOT Form 725-030-11, and with knowledge of driving duties, I find that this person:
Note certification status here and on the medical examination form. If applicable, only when:
MEETS STANDARDS (RE-EXAMINE IN 2 YEARS) Corrective Lenses
DOES NOT MEET STANDARDS Wearing hearing aid
MEETS STANDARDS, BUT PERIODIC EVALUATION REQUIRED
Temporarily disqualified due to:
DRIVER IS QUALIFIED ONLY FOR:
3-MONTHS 6-MONTHS 1 YEAR OTHER
Return to medical examiner’s office for follow-up on
The information I have provided regarding this physical examination is true and complete. A complete examination form with any attachments embodies my findings completely and correctly,
and is on file in my office.
Medical Examiner’s Signature: Telephone: Date:
Medical Examiner’s License or certificate number
Medical Examiner’s Name: (Print)
Issuing State:
MD Physician Advanced Registered Nurse
DO Assistant Practitioner
Office Address: (Print)
CITY COUNTY STATE ZIP
Name of Driver: (Print) Driver License No. Issuing State:
Signature of Driver: Date:
Rule 14-90.0041, F.A.C. 725-030-11
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INSTRUCTIONS TO THE MEDICAL EXAMINER
General Information
The purpose of this examination is to determine a driver’s physical qualification to operate a bus according to the requirements in Rule 14-
90.0041, Florida Administrative Code, and referenced Department Form 775-030-01, including the qualification criteria set forth below. The
medical examiner must be knowledgeable of these requirements and instructions to assist the medical examiner in making the qualification
determination. The medical examiner should be familiar with the driver’s responsibilities and work environment. In addition to reviewing the
Health History section with the driver and conducting the medical 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 and educate the driver to read the warning
labels on all medications. History of certain conditions may be cause for rejection, as determined by the medical examiner. The medical
examiner may indicate the need for additional laboratory tests or more stringent examination perhaps by a medical specialist. These decisions
should be made in light of the driver’s job responsibilities, work schedule, and potential for the conditions 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, the medical examiner signs and dates the Medical Examiner’s Certificate. 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 examiner shall determine if the medical certificate should be issued for a shorter length of time. The
medical examination should be done carefully and at least as complete as indicated by the indicated advisory and qualification criteria.
Advisory and Qualification Standards
Extremities. Carefully examine upper and lower extremities. Note any and all deformities, the presence of atrophy, semi-paralysis or paralysis,
or varicose veins. Record the loss or impairment of a hand or finger which interferes with prehension or power grasping; or an arm, foot, or leg
which interferes with ability to perform normal tasks associated with operating a bus; or any other significant limb defect or limitation which
interferes with ability to perform normal tasks associated with operating a bus. If a hand or finger deformity exists, determine whether sufficient
grasp is present to enable the driver to secure and maintain a grip on the steering wheel. If a leg deformity exists, determine whether sufficient
mobility and strength exist to enable the driver to operate pedals properly. Particular attention should be give to and a record should be made of,
any impairment or structural defect that may interfere with the driver's ability to operate a bus safely.
Diabetes. Pre-employment Medical Examination:
If, during a pre-employment examination, it is noted that a driver applicant has a medical
history or clinical diagnosis of diabetes mellitus requiring insulin for control, the person shall not be qualified to drive a bus. Biennial Medical
Examination: If diabetes is noted for an existing driver at the time of his or her examination, excluding pre-employment, and the diabetic
condition is stabilized or controlled by insulin, oral medication and/or diet that can be obtained while the driver is on duty, then the driver may be
qualified. Notwithstanding, the driver must remain under medical supervision as determined by the medical examiner.
Cardiovascular Condition. A person is qualified 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 heart failure. The term “has no current clinical diagnosis of” is specially designed to encompass: “a clinical diagnosis of” (1) a current
cardiovascular condition, or (2) a cardiovascular which has not fully stabilized, regardless of the time limit. The term “known to be accompanied
by” is defined to include a clinical diagnosis or 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. 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 bus transit system. 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 disqualifying. Coumadin is a medical
treatment that can improve the health and safety of a driver and should not, by its use, medically disqualify the driver. The emphasis should be
on the underlying medical conditions that require treatment and the general health of the driver.
Respiratory Dysfunction. A person is qualified if that person has no established medical history or clinical diagnosis of a respiratory dysfunction
likely to interfere with the ability to control and drive a bus safely. Since a driver must be alert at all times, any change in his/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, which is in any way likely to interfere with the driver’s ability to safely control and drive a bus, the
driver must be referred to a specialist for further evaluation and therapy. Anticoagulation therapy for deep vein thrombosis and/or pulmonary
thromboebolism is not disqualifying once optimum dosage is achieved, provided lower extremity venous examinations remain normal and the
treating physician gives a favorable recommendation.
Hypertension. A person is qualified if that person has no current clinical diagnosis of high blood pressure likely to interfere with the ability to
operate a bus safely. A blood pressure of greater then 161-180 and/or 91-104 diastolic is considered mild hypertension, and the driver is not
necessarily unqualified during evaluation and institution of treatment. The driver is given a 3-month period to reduce his/her blood pressure to
less than or equal to 160/90; the certifying physician should state on the medical certificate that it is only valid for that 3
-month period. If the
driver is subsequently found qualified with a blood pressure less then or equal to 160/90, the certifying may issue a medical certificate for a 1-
year period, but should confirm blood pressure control in the third month of this 1-year period. The individual should be certified annually
thereafter. The expiration date must be stated on the medical certificate. A blood pressure greater then 180 systolic and/or greater then 104
diastolic is considered moderate to severe. The driver may not be qualified, even temporarily, until his/her blood pressure has been reduced to
less than 181/105. The examining physician may temporarily certify the individual once the individual’s blood pressure is below 181 and/or 105.
For blood pressure greater then 180 and/or 104, documentation of continued control should be made every 6 months. The individual should be
certified biannually thereafter. The expiration date must be stated on the medical certificate. Drivers with normal blood pressure who are taking
medications for hypertension should be certified on the same basis as individuals with blood pressure in the mild or moderate to severe range.
Annual re-certification is recommended if the medical examiner is unable to establish the blood pressure at the time of diagnosis. An elevated
blood pressure finding should be confirmed by at least two subsequent measurements on different days. Inquiry should be made regarding
smoking, cardiovascular disease in relatives, and immoderate use of alcohol. An electrocardiogram (ECG) and blood profile, including glucose,
cholesterol, HDL cholesterol, creatinine and potassium, should be made. An echocardiogram and chest x-ray is desirable in subjects with
moderate and severe hypertension.
Since the presence of target damage increases the risk of sudden collapse, group 3 or 4 hypertensive retinopathy, left ventricular hypertrophy not
otherwise explained (echocardiography or ECG by Estes criteria) evidence of severely reduced left ventricular function, or serum creatinine of
greater then 2.5 warrants the driver being found unqualified to operate a bus. Treatment nonpharmacologic and pharmacologic modalities as well
as counseling to reduce other risk factors. Most anti-hypertensive medications also have side effects, the importance of which must be judged on
Rule 14-90.0041, F.A.C. 725-030-11
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05/09
an individual basis. Individuals must be alerted to the hazards of these medications while driving. Side effects of somnolence or syncope are
particularly undesirable in bus drivers. A driver who has normal blood pressure 3 or more months after a successful operation for
pheochromocytoma, primarily aldosteronism (unless bilateral adrenalectomy has been performed), renovascular disease or unilateral renal
parenchymal disease, and who shows no evidence of target organ may be qualified. Hypertension that persists, despite surgical intervention,
should be evaluated and treated following the guidelines set forth in this section.
Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease. A person is qualified if that person has no established
medical history or clinical diagnosis of Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease, which interferes with
the ability to control and operate a bus safely. Certain diseases are known to have acute episodes of transient muscle weakness, poor muscle
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 movement and eventually interfere with the ability to drive safely. In many instances these diseases
are degenerative in nature or may result in the deterioration of the involved area. Once the individual has been diagnosed with having Rheumatic,
Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease, then he/she has an established history of that disease. The physician when
examining the 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 the limitation present (such as range of motion); 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 when more frequent monitoring is required, a certificate for a shorter time period may be issued.
Epilepsy. A person is qualified 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 bus. Epilepsy is a chronic functional disease characterized by seizures or
episodes that occur without warning, resulting in loss of voluntary control that 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; or (2) a driver who has a current clinical diagnosis of
epilepsy; or (3) a driver who is taking anti-seizure medication. If an individual has had a sudden episode of non-epileptic seizure or loss of
consciousness of an unknown cause which did not require anti-seizure medication, that decision as to whether the person’s condition will likely
cause loss of consciousness or loss of ability to control a bus is made on an individual basis by the medical examiner 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 complete a neurological examination. If the results of the examination are
negative and anti-seizure medication is not required, then the driver may be qualified. In those individual cases where a driv
er 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 acute metabolic disturbance), certification should be deferred until the driver has fully recovered from that condition and has no
existing residual complications, and not taking anti-seizure medication.
Mental Disorders. A person is qualified if that person has no mental, nervous, organic or functional disease or psychiatric disorder likely to
interfere with ability to drive a bus 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 uncoordination, 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 driving is inadvisable. Somatic and psychosomatic complaints should be thoroughly examined when determining an
individual’s overall fitness to drive. Disorders of a periodical incapacitating nature, even in the early stages of development, may warrant
disqualification. Many bus 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 driving a bus. When examining the driver, it should be kept in mine that individuals who live under chronic emotional upsets
might have deeply ingrained maladaptive or erratic behavior patterns. Excessively antagonistic, instinctive, impulsive, openly aggressive,
paranoid or severely depressed behavior may greatly interfere with the drivers 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.
Vision. A person is qualified if that person meets the vision standard established by the State of Florida for Operator and Commercial Driver
License, as applicable. The current standards are as follows: Must have visual acuity of 20/40 (Snellen) (or better) in one eye, must have 20/40
(or better) vision in the other eye, with or without corrective lenses. If 20/70 (or better) vision in either eye separately, or in both eyes together,
the worst eye must have vision screening better than 20/200, with or without corrective lenses. Referral to an eye doctor is recommended. If an
individual meets the criteria by use of glasses or contact lenses, the following statement shall appear on the Medical Examiner’s Certificate:
“Qualified only if wearing corrective lenses.
Hearing. A person is qualified if that person 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 of hearing loss in the better greater then 40 decibels at 500
Hz, 1,000 Hz and 2,000 Hz, with or without a hearing aid or audiometric device calibrated to American National Standard (former
ly ASA
standard) Z24.5-1951. The prescribed standard is under the American Standards Association (ANSI), therefore 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 the hearing aid and have it in operation at all times while driving. For
the whispered voice test, the driver should be stationed at least 5 feet away from the examiner with the ear being tested towards 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 (s-sounding test materials). The opposite ear should be tested in the same manner. If the
individual fails the whisper test, the audiometric test should be administered. If the individual meets the criteria by use of a hearing aid, the
following statement shall appear on the Medical Examiner’s Certificate: “Qualified only when wearing a hearing aid”.
Rule 14-90.0041, F.A.C. 725-030-11
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INSTRUCTIONS FOR PERFORMING AND RECORDING MEDICAL EXAMINATIONS
The medical examiner should review these instructions before
performing the medical
examination. Answer each question yes or
no, where appropriate. The examiner should be aware of the
rigorous physical demands and mental and emotional responsibilities
placed on the bus transit system driver. In the interest of public
safety, the examination shall ensure that the driver does not have
any physical, mental, or organic defect of such a nature as to affect
the driver’s ability to operate safely a bus according to the criteria on
the Medical Examination Report and any additional requirements
established by the bus transit system.
General Information. The purpose of this history and medical
examination is to detect the presence of physical, mental, or organic
defects of such a character and extent as to affect the
applicant/driver’s ability to operate a bus safely according to these
criteria and any additional physical requirements established by the
bus transit system. The examination should be made carefully and
at least as complete as indicated by these criteria and instructions.
History of certain defects may be cause for rejection or indicate the
need for making certain laboratory tests or a further, and more
stringent, examination. Defects may be recorded which do not,
because of their character or degree, indicate that medical
qualification should be denied. However, these defects should be
discussed with the driver/applicant and he/she should be advised to
take the necessary steps to insure correction, particularly those of
which, if neglected, might lead to a condition likely to affect his/her
ability to drive safely.
General Appearance and Development. Note marked overweight.
Note any posture defect, perceptible limp, tremor, or other defects
that might be caused by alcoholism, thyroid intoxication, or other
illnesses. Federal Transit Administration regulations prohibit use of
controlled substances by a driver.
Head - Eyes. When other than the Snellen chart is used, the results
of test must be expressed in values comparable to the standard
Snellen test. If the applicant/driver wears corrective lenses, these
should be worn while applicant/driver’s visual acuity is being tested.
In recording distance vision use 20 feet as normal. Report all vision
as a fraction with 20 as numerator and the smallest type read at 20
feet as denominator. Note ptosis, discharge, visual fields, ocular
muscle imbalance, color blindness, corneal scar, exophthalmos, or
strabismus, uncorrected by corrective lenses. If the applicant/
driver
habitually wears contact lenses, or intends to do so while driving,
there should be sufficient evidence to indicate that he/she has good
tolerance and is well adapted to their use. The use of contact lenses
should be noted on the record.
Ears. Note evidence of mastoid or middle ear disease, discharge,
symptoms of aural vertigo, or Meniere’s Syndrome. When recording
hearing, record distance from patient from which a forced whispered
voice can first be heard. If audiometer is used to test hearing, record
decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz.
Throat. Note evidence of disease, irremediable deformities of the
throat likely to interfere with eating or breathing, or any laryngeal
condition which could interfere with the safe operation of a bus.
Thorax - Heart. Stethoscopic examination is required. Note
murmurs and arrhythmias, and any past or present history of
cardiovascular disease, of a variety known to be accompanied by
syncope, dyspnea, collapse, enlarged heart or congestive heart
failures. Electrocardiogram is required when findings so indicate.
Blood Pressure. Record with either spring or mercury column type
sphygmomanometer. If the blood pressure is consistently above
160/90 mm. Hg., further tests may be necessary to determine
whether the driver is qualified to operate a bus.
Lungs. If any lung disease is detected, state whether active or
arrested; if arrested, your opinion as to how long it has been
quiescent.
Gastrointestinal System. Note any diseases of the gastrointestinal
system.
Abdomen. Note wounds, injuries, scars, or weakness of muscles of
abdominal walls sufficient to interfere with normal function. Any
hernia should be noted if present. State how long and if adequately
contained by truss.
Abnormal Masses. If present, note location, if tender, and whether
or not the applicant/driver knows how long they have been present.
If the diagnosis suggests that the condition might interfere with the
control and safe operation of a bus, more stringent tests are
recommended.
Tenderness. When noted, state where most pronounced, and
suspected cause. If the diagnosis suggests that the condition might
interfere with the control and safe operation of a bus, more stringent
tests are recommended.
Genito - Urinary. Urinalysis is required. Acute infections of the
genito-urinary tract, as defined by local and State public health laws,
indications from urinalysis of uncontrolled diabetes, symptomatic
albumin-urea in the urine, or other findings that may indicate health
conditions likely to interfere with the control and safe operation of a
bus.
Neurological. If positive Romberg is reported, indicate degrees of
impairment. Pupillary reflexes should be reported for both light and
accommodation. Knee jerks are to be reported absent only when not
obtainable upon reinforcement and as increased when the foot is
actually lifted from the floor following a light blow on the patella,
sensory vibratory and positional abnormalities should be noted.
Extremities. Carefully examine upper and lower extremities.
Record the loss of impairment of a leg, foot, toe, arm, hand, or
fingers. Note any and all deformities, the presence of atrophy,
semiparalysis or paralysis, or varicose veins. If a hand or finger
deformity exists, determine whether sufficient grasp is present to
enable the driver to secure and maintain a grip on the steering
wheel. If a leg deformity exists, determine whether sufficient mobility
and strength exist to enable the driver to operate pedals properly.
Particular attention should be give to and a record should be made
of, any impairment or structural defect which may interfere with the
driver’s ability to operate a bus safely.
Spine. Note deformities, limitation of motion, or any history of pain,
injuries or disease, past or presently experienced in the cervical or
lumbar spine region. If findings so dictate, radiologic and other
examinations should be used to diagnose congenital or acquired
defects; or spondylolisthesis and scoliosis.
Recto - Genital Studies.
Disease or conditions causing discomfort
should be evaluated carefully to determine the extent to which the
condition might be handicapping while lifting, pulling or during
periods of prolonged driving that might be necessary as part of the
driver’s duties.
Laboratory and Other Special Findings. Urinalysis is required; as
well as such other tests as the medical history or findings upon
medical examination may dictate are necessary. A serological test is
required if the applicant/driver has a history of luetic infection or
present physical findings indicate the possibility of latent syphilis.
Other studies deemed advisable may be ordered by the examining
physician.
Diabetes. Pre-employment medical examination: If, during a pre-
employment examination, it is noted that a driver applicant has a
medical history or clinical diagnosis of diabetes mellitus requiring
insulin for control, the person shall not be qualified to drive a bus.
Biennial medical examination: If diabetes is noted for an existing
driver at the time of his or her examination, excluding pre-
employment, and the diabetic condition is stabilized or controlled by
insulin, oral medication and/or diet that can be obtained while the
driver is on duty, then the driver may be qualified. Notwithstanding,
the driver must remain under medical supervision as determined by
the medical examiner.
Upon completion of the examination, the examiner must date and sign
the form and certificate and also provide his/her full name, and address
of the examination office.
Form Information
| Fact Name | Details |
|---|---|
| Governing Law | Rule 14-90.0041, Florida Administrative Code (F.A.C.) |
| Form Purpose | This form assesses the medical fitness of drivers for bus transit systems in Florida. |
| Driver Information | Drivers must provide personal details including name, birthdate, and contact information. |
| Health History | Drivers indicate any existing or past medical conditions that may affect driving ability. |
| Vision Standards | Drivers must meet specific visual acuity requirements, with or without corrective lenses. |
| Hearing Standards | Drivers must perceive a whispered voice from at least 5 feet away or meet audiometric standards. |
| Blood Pressure Evaluation | Initial blood pressure readings must be recorded; specific thresholds determine qualification. |
| Certification Duration | Medical certificates are typically valid for two years unless otherwise specified by the examiner. |
Detailed Guide for Filling Out Florida Dot Medical
Completing the Florida Department of Transportation (FDOT) Medical Examination Report for Bus Transit System Drivers is an essential step in ensuring that drivers meet the necessary health standards to operate a bus safely. The following steps will guide you through the process of filling out the form accurately and completely.
- Gather Personal Information: Begin by collecting your personal details, including your full name (last, first, middle), birthdate, age, sex, and address (city, state, zip code).
- Driver License Information: Provide your driver license number and the date it was issued. Indicate the license class (A, B, C, D, or other).
- Contact Information: Fill in your work and home telephone numbers.
- Exam Dates: Specify the date of your preemployment exam or any follow-up exams, using the MM/DD/YY format.
- Health History: Carefully review the health history section. Answer "Yes" or "No" to each medical condition listed. If you answer "Yes" to any condition, provide additional details such as onset date, diagnosis, treating physician’s name and address, and current limitations.
- Medication List: List all medications you are currently taking, including over-the-counter drugs.
- Driver's Certification: Sign and date the form to certify that the information provided is complete and true. Understand that inaccuracies may invalidate the examination.
- Medical Examiner's Review: The medical examiner will review your health history and any "Yes" answers. They will also perform necessary tests, including vision, hearing, blood pressure, and a physical examination.
- Testing Results: The medical examiner will record the results of the vision and hearing tests, blood pressure readings, and any other laboratory findings.
- Medical Examination Certificate: Once the medical examiner completes their assessment, they will provide you with a Medical Examination Certificate indicating your qualification status.
After completing the form, you will need to submit it to your medical examiner for their review and signature. This process ensures that all necessary health checks are conducted before you can continue your duties as a bus driver. Be sure to keep a copy of the completed form for your records.
Obtain Answers on Florida Dot Medical
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What is the purpose of the Florida DOT Medical Form?
The Florida DOT Medical Form is designed to assess the physical qualifications of individuals applying to operate a bus. It ensures that drivers meet health and safety standards set by the Florida Department of Transportation. This evaluation includes a review of the driver’s medical history, vision, hearing, blood pressure, and overall physical condition.
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Who is required to complete this form?
Any individual seeking to drive a bus in Florida must complete the Florida DOT Medical Form. This requirement applies to both new applicants and existing drivers who need to renew their medical certification. Regular medical evaluations are crucial to ensure that all drivers are fit to operate a bus safely.
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What information must a driver provide on the form?
Drivers must provide personal information such as their name, birthdate, and contact details. They also need to disclose their medical history, including any past or current health conditions. Additionally, drivers must list any medications they are taking, as this information is vital for the medical examiner to assess their fitness to drive.
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What happens if a driver answers "yes" to any health history questions?
If a driver answers "yes" to any questions regarding their health history, the medical examiner will review those responses in detail. This discussion may include the onset date, diagnosis, and any limitations the driver may have. It is essential for the medical examiner to understand the driver’s health to make an informed decision about their qualifications.
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How often must drivers undergo medical examinations?
Drivers are required to undergo medical examinations every two years. However, if a driver has specific medical conditions that need closer monitoring, the medical examiner may issue a certificate valid for a shorter duration. Regular check-ups help ensure that any health issues are managed appropriately and do not compromise driving safety.
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What are the vision requirements for bus drivers?
Bus drivers must meet specific vision standards set by the State of Florida. They should have a visual acuity of at least 20/40 in each eye, with or without corrective lenses. If corrective lenses are needed, this must be noted on the medical certificate. Drivers who do not meet these standards may need to seek further evaluation from an eye specialist.
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What should a driver do if they have a medical condition?
Drivers with medical conditions should be open and honest when completing the Florida DOT Medical Form. It is crucial to disclose any health issues, as this information allows the medical examiner to evaluate their fitness to drive safely. If a condition is well-managed and does not pose a risk, the driver may still qualify. However, ongoing medical supervision may be necessary.
Common mistakes
Filling out the Florida Department of Transportation Medical Examination Report can be a straightforward process, but several common mistakes can lead to complications or disqualification. One significant error is failing to provide complete and accurate health history. When answering questions about past medical conditions, it is crucial to be thorough. Omitting details or providing vague responses can raise red flags during the examination. It is essential to remember that the medical examiner relies on this information to assess the driver's fitness for duty.
Another common mistake is neglecting to disclose all medications currently being taken. This includes prescription medications as well as over-the-counter drugs. Drivers may underestimate the importance of this information, but certain medications can have side effects that impact driving ability. By failing to list these medications, drivers risk being deemed unqualified if the medical examiner discovers undisclosed information later. Transparency is key to ensuring safety on the road.
Additionally, many individuals misunderstand the vision and hearing requirements outlined in the form. It is vital to be aware of the standards for visual acuity and hearing ability. If corrective lenses or hearing aids are necessary, drivers must indicate this clearly on the form. Misunderstanding these requirements can lead to disqualification during the examination, even if the driver meets other health standards. Ensuring compliance with these specific requirements can help avoid unnecessary complications.
Lastly, many drivers overlook the importance of reviewing the form before submission. Taking the time to double-check all entries for accuracy can prevent issues down the line. Errors such as incorrect dates, miswritten names, or incomplete sections can lead to delays or the need for re-examination. By carefully reviewing the form, drivers can ensure that their application is processed smoothly and efficiently, allowing them to focus on their primary responsibilities.
Documents used along the form
The Florida DOT Medical form is a crucial document for bus transit system drivers, ensuring they meet health standards necessary for safe operation. Alongside this form, several other documents are often required to complete the medical examination and certification process. Here’s a list of commonly used forms and documents that complement the Florida DOT Medical form:
- Medical Examination Certificate: This document certifies that a driver has been examined and meets the medical standards set by the Florida Department of Transportation. It indicates the driver's qualification status and any conditions that may require further monitoring.
- Health History Questionnaire: Before the medical exam, drivers typically fill out a health history questionnaire. This form gathers information about past and current medical conditions, medications, and any relevant health issues that may affect driving ability.
- Vision Test Report: This report details the results of the vision tests conducted by the medical examiner. It confirms whether the driver meets the required visual acuity standards, with or without corrective lenses.
- Hearing Test Report: Similar to the vision report, this document records the results of the hearing tests. It ensures that the driver can perceive sounds necessary for safe driving, either with or without hearing aids.
- Blood Pressure Evaluation Form: This form records the driver’s blood pressure readings during the examination. It helps determine whether the driver’s blood pressure is within acceptable limits for safe driving.
- Urinalysis Results: A urinalysis is often required to check for underlying medical conditions such as diabetes or kidney issues. The results are documented and can indicate further testing if abnormalities are found.
- Follow-Up Examination Report: If a driver is found to have a medical condition that requires monitoring, a follow-up examination report is completed. This document tracks the driver’s health status over time.
- Physician’s Notes: Any additional notes or comments from the medical examiner regarding the driver’s health can be recorded here. These notes provide context for the examination results and any recommendations for the driver.
- Employer Notification Form: This form is often sent to the driver’s employer, confirming the driver’s medical status and any restrictions or recommendations made by the medical examiner.
- Driver’s License Verification: A copy of the driver’s current license may be required to confirm their eligibility to operate a bus and ensure compliance with state regulations.
These documents work together to create a comprehensive view of a driver’s health, ensuring that they are fit for duty. Proper completion and submission of these forms not only uphold safety standards but also protect the well-being of both the driver and the passengers they serve.
Similar forms
- Commercial Driver's License (CDL) Medical Examination Report: Similar to the Florida DOT Medical form, the CDL Medical Examination Report assesses a driver's physical fitness to operate commercial vehicles. It includes sections on health history, vision, hearing, and other medical evaluations to ensure that drivers meet safety standards.
- Federal Motor Carrier Safety Administration (FMCSA) Medical Examination Report: This report is required for interstate commercial drivers and evaluates the same health aspects as the Florida DOT form. It focuses on the driver's ability to safely operate a commercial vehicle based on medical history and current health status.
- Department of Transportation (DOT) Physical Examination: The DOT Physical Examination is a comprehensive assessment to determine whether an individual is medically qualified to operate a commercial vehicle. It includes similar sections on health history, physical exams, and vision and hearing tests.
- Driver Health Questionnaire: This document collects information about a driver's medical history and current health conditions. Like the Florida DOT Medical form, it aims to identify any potential health issues that could impair driving ability.
- State-Specific Medical Evaluation Forms: Many states have their own medical evaluation forms for drivers. These documents often mirror the Florida DOT Medical form in structure and purpose, focusing on health history and physical capabilities necessary for safe driving.
- Occupational Health Assessment: This assessment evaluates an employee's health in relation to their job requirements. Similar to the Florida DOT Medical form, it addresses specific health concerns that could impact job performance, particularly in safety-sensitive positions.
- Pre-Employment Medical Examination: This examination is conducted before hiring and assesses a candidate's overall health and fitness for a specific role. It shares similarities with the Florida DOT Medical form, as both evaluate medical history and current health status.
- Return-to-Work Medical Clearance: This document is required for employees returning to work after a medical leave. It assesses whether they are fit to resume their duties, similar to the Florida DOT Medical form's focus on ensuring drivers are medically qualified.
- Health Risk Assessment (HRA): An HRA evaluates an individual's health risks and provides insights into their medical history. Like the Florida DOT Medical form, it aims to identify health issues that could affect performance, particularly in driving roles.
- Vision and Hearing Screening Forms: These forms specifically assess a driver's vision and hearing capabilities. They align with the Florida DOT Medical form's sections that focus on visual and auditory standards necessary for safe driving.
Dos and Don'ts
When filling out the Florida DOT Medical form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are ten things to consider:
- Do provide complete and accurate information about your health history.
- Do disclose any medications you are currently taking, including over-the-counter drugs.
- Do ensure that you have your driver's information ready, including your license number and date of issue.
- Do be honest about any health conditions that may affect your ability to drive safely.
- Do have your vision and hearing checked prior to the examination to ensure you meet the required standards.
- Don't leave any sections of the form blank; incomplete forms may lead to delays or disqualification.
- Don't attempt to hide any medical conditions; this could have serious consequences for your driving qualifications.
- Don't forget to sign and date the form; your signature certifies that the information provided is true.
- Don't assume that previous medical conditions are no longer relevant; they should still be disclosed.
- Don't wait until the last minute to schedule your examination; allow ample time for any follow-up if needed.
Misconceptions
- Misconception 1: The Florida DOT Medical form is only for new drivers.
- Misconception 2: A driver can be disqualified for any medical condition.
- Misconception 3: Vision and hearing tests are optional.
- Misconception 4: Medications do not need to be disclosed.
- Misconception 5: The medical examiner's decision is final and cannot be challenged.
This form is required for both new applicants and existing drivers. Regular biennial examinations are mandatory to ensure ongoing fitness to drive.
Not all medical conditions lead to disqualification. Many drivers can still qualify if their conditions are well-managed and do not impair driving ability.
These tests are essential components of the medical examination. Drivers must meet specific standards for vision and hearing to ensure safety on the road.
All medications, including over-the-counter drugs, must be reported. Some medications can affect driving ability, and the medical examiner needs this information for a proper assessment.
Drivers have the right to seek a second opinion or appeal a disqualification. Communication with the medical examiner is encouraged to discuss concerns or seek clarification.
Key takeaways
Filling out and using the Florida DOT Medical Form is an essential process for bus transit system drivers. Here are some key takeaways to keep in mind:
- Accurate Information is Crucial: Drivers must provide truthful and complete information on their health history. Any inaccuracies could invalidate the examination.
- Health History Section: This section requires drivers to disclose any medical conditions or medications. Be prepared to discuss any "yes" answers with the medical examiner.
- Vision Standards: Drivers need to meet specific vision standards. If corrective lenses are used, this must be noted by the medical examiner.
- Hearing Requirements: Drivers must be able to perceive a forced whispered voice from at least five feet away, with or without a hearing aid.
- Blood Pressure Monitoring: Blood pressure readings are critical. If readings exceed certain thresholds, the driver may need to be re-evaluated after a period of treatment.
- Diabetes Management: Drivers with diabetes must ensure their condition is controlled. Those requiring insulin may face disqualification during pre-employment examinations.
- Medical Examiner's Role: The medical examiner is responsible for assessing the driver's overall health and fitness to operate a bus safely.
- Certification Validity: The medical certificate is typically valid for two years, but may be shorter if the driver has specific medical conditions that require closer monitoring.
- Follow-Up Visits: If a driver is temporarily disqualified or requires follow-up evaluations, these must be scheduled promptly to ensure compliance with safety standards.
By understanding these key points, drivers can navigate the medical examination process with greater confidence and clarity.