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Fmcsa Form 2013

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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 requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. Additionally these misstatements are punishable as perjury under 18 USC 1621 which provides for fines up to 2 000 or imprisonment up to 5 years for each offense. I further certify under penalty of perjury under the laws of the United...

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What is the FMCSA Form?

The FMCSA 391 65 form is a crucial document used by the Federal Motor Carrier Safety Administration (FMCSA) to ensure that commercial drivers meet the necessary medical standards for safe operation of commercial vehicles. This form is specifically designed for drivers to report their medical history and any medical conditions that may affect their ability to drive safely. It serves as a vital tool for employers to assess the fitness of their drivers and comply with federal regulations.

How to Use the FMCSA Form

Using the FMCSA 391 65 form involves several steps to ensure that all required information is accurately reported. First, drivers must fill out the form with detailed information about their medical history, including any previous conditions, medications, and treatments. Once completed, the form should be submitted to a certified medical examiner who will review the information and conduct a physical examination. The medical examiner will then determine if the driver meets the necessary health standards to operate a commercial vehicle.

Steps to Complete the FMCSA Form

Completing the FMCSA 391 65 form requires careful attention to detail. Follow these steps:

  • Obtain the latest version of the FMCSA 391 65 form from a reliable source.
  • Provide personal information, including your name, address, and date of birth.
  • Detail your medical history, including any chronic conditions, surgeries, or medications.
  • Sign and date the form to certify that the information provided is accurate.
  • Submit the completed form to a certified medical examiner for evaluation.

Legal Use of the FMCSA Form

The FMCSA 391 65 form is legally binding when filled out correctly and signed. It is essential for maintaining compliance with federal regulations governing commercial driver health standards. Failure to complete or submit this form can result in penalties for both the driver and the employer, including fines and potential disqualification from operating commercial vehicles.

Key Elements of the FMCSA Form

Several key elements must be included in the FMCSA 391 65 form to ensure its validity:

  • Driver Information: Full name, address, and contact details.
  • Medical History: Comprehensive details about past and present medical conditions.
  • Medications: A list of all medications currently being taken.
  • Signature: The driver's signature certifying the accuracy of the information.

Form Submission Methods

The FMCSA 391 65 form can be submitted through various methods, including:

  • In-Person: Delivering the form directly to a certified medical examiner.
  • Mail: Sending the completed form via postal service to the appropriate medical office.
  • Online: Some medical examiners may offer digital submission options through secure platforms.

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VersionsForm popularityFillable & printable
FMCSA OP-1 20244.5 Satisfied (49 Votes)
FMCSA OP-1 20234.8 Satisfied (456 Votes)
FMCSA OP-1 20204.8 Satisfied (4490 Votes)
FMCSA OP-1 20134.8 Satisfied (2211 Votes)
FMCSA OP-1 20114.8 Satisfied (733 Votes)
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The FMCSA 391 65 form is a medical examination report used to determine if a commercial driver's health meets safety standards. It is critical for ensuring that drivers are physically able to operate commercial vehicles without endangering themselves or others on the road.

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