DOT Physical: Requirements, Exam and Employer Checklist

A DOT physical is the medical examination a commercial motor vehicle (CMV) driver must pass to show they are physically qualified to drive under Federal Motor Carrier Safety Administration (FMCSA) rules. It must be performed by a medical examiner listed on FMCSA’s National Registry, and a passing result is valid for up to 24 months.

This guide explains the exam, how drivers prepare, how to find a certified examiner, how long a certificate lasts and how employers handle it. GoodHire does not perform DOT physicals. For the wider set of DOT hiring checks, see GoodHire’s DOT background check overview. For the full list of documents in a driver’s file, see the driver qualification file checklist.

What Is a DOT Physical?

A DOT physical, also called a DOT medical exam, checks whether a driver meets the physical qualification standards in 49 CFR 391.41. A driver who passes receives a Medical Examiner’s Certificate, often called a DOT medical card.

Under 49 CFR 391.43, the exam must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners. FMCSA says these examiners include, but are not limited to, doctors of medicine (MD), doctors of osteopathy (DO), physician assistants (PA), advanced practice nurses (APN) and doctors of chiropractic (DC). A licensed ophthalmologist or optometrist may perform the vision portion.

A DOT physical is not a DOT drug test. Pre-employment and other drug and alcohol testing for drivers who need a commercial driver’s license (CDL) fall under separate rules.

Who Needs a DOT Physical?

The requirement applies to drivers of commercial motor vehicles in interstate commerce, whether or not they need a CDL. Under 49 CFR 390.5, a vehicle is a CMV when it:

• Has a gross vehicle weight rating or gross combination weight rating, or actual gross weight, of 10,001 pounds or more
• Is designed or used to carry more than 8 passengers, including the driver, for compensation
• Is designed or used to carry more than 15 passengers, including the driver, not for compensation
• Carries hazardous materials in a quantity that requires placards

Under 49 CFR 391.45, a driver must be examined and certified:

• Before driving a CMV for the first time, if they have never been certified
• At least once every 24 months, or sooner if their certificate was issued for a shorter period
• After an injury or illness that has impaired their ability to perform their normal duties

Part 391 has limited exceptions for certain operations. Drivers who operate only within one state are generally covered by state rules, which may differ from the federal standards.

What Does a DOT Physical Test?

The driver first completes a health history on the Medical Examination Report Form, MCSA-5875, and the examiner reviews it with them. The examiner then performs a physical exam and records the results on the same form. The main federal standards are:

Area	Federal standard or check
Vision	At least 20/40 in each eye and in both eyes together, with or without glasses or contacts; a horizontal field of vision of at least 70 degrees in each eye; and the ability to recognize red, green and amber traffic signal colors. Drivers who do not meet the standard with the worse eye may qualify under an alternative standard (see below).
Hearing	Hears a forced whisper at 5 feet or more in the better ear, with or without a hearing aid, or passes an audiometric test with an average loss of no more than 40 decibels in the better ear.
Blood pressure and pulse	Measured at the exam. The rule disqualifies a current diagnosis of high blood pressure likely to interfere with safe driving.
Urinalysis	Checks for protein, blood or sugar in the urine, which may prompt further testing for an underlying condition. It is not a drug test.
Physical exam	Covers systems such as the heart, lungs, abdomen, spine, limbs and nervous system, looking for conditions likely to interfere with safe driving.
Medications and substances	A driver cannot use Schedule I drugs. Other controlled substances are allowed only when prescribed by a licensed practitioner who knows the driver’s medical history and has advised that the drug will not affect safe driving.

The rule also covers limb impairments, heart and lung disease, epilepsy and other conditions that can cause loss of consciousness, psychiatric disorders and alcoholism. Many conditions do not disqualify a driver automatically. The examiner decides case by case.

What changed for vision in 2022?

Since March 22, 2022, drivers who cannot meet the vision standard with the worse eye may qualify under the alternative vision standard in 49 CFR 391.44, which replaced FMCSA’s vision exemption program. An ophthalmologist or optometrist first completes a Vision Evaluation Report, Form MCSA-5871. The DOT exam must begin within 45 days after that report is signed, and the driver must be re-examined at least once a year. A driver who qualifies under this standard for the first time generally must pass a road test with the employer before driving, unless an exception in the rule applies.

Can drivers with insulin-treated diabetes pass?

Yes, if they meet the conditions in 49 CFR 391.46, in effect since November 19, 2018. A federal exemption is no longer needed. The driver’s treating clinician completes the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, and the DOT exam must take place no later than 45 days after it is signed. The certificate lasts up to 12 months, or up to 3 months if the driver cannot provide at least 3 months of electronic blood glucose records. After a severe low blood sugar episode, the driver must stop driving until a treating clinician clears them.

How Should a Driver Prepare for a DOT Physical?

Drivers should bring:

• Their driver’s license. For CDL and commercial learner’s permit (CLP) holders, results are matched to the state record by name, date of birth, license number and state, so the form must match the license exactly.
• A list of current medications.
• Glasses, contact lenses or hearing aids they use.
• Treating clinician records for any ongoing condition.
• A completed Form MCSA-5870 if they take insulin, or Form MCSA-5871 if they are qualifying under the alternative vision standard.
• Any FMCSA medical variance, such as an exemption letter or a Skill Performance Evaluation certificate.

FMCSA’s National Registry guidance for drivers suggests scheduling the exam well before the current certificate expires. That leaves time to fix any errors in reporting results to the state.

How Do You Find a Certified Medical Examiner?

Use the National Registry search tool to find examiners by location or name. Before sending a driver to a clinic, confirm that the specific examiner is listed, not just the clinic. Federal rules require the examiner to be listed on the National Registry when the certificate is issued.

For drivers who do not need a CDL, your company must also verify the examiner’s National Registry listing and keep a note of that check in the driver qualification (DQ) file, under 49 CFR 391.23(m)(1). For CDL and CLP holders, this separate verification step ended June 23, 2025, because only listed examiners can submit results to the National Registry.

What Are the Possible Results, and How Long Is the Certificate Valid?

The maximum certificate length is 24 months. The examiner can certify a driver for a shorter period when a condition needs monitoring. Some shorter periods are set by regulation. Others, including the blood pressure intervals, come from FMCSA’s Medical Advisory Criteria, which the agency describes as strictly advisory and without the force of law. The examiner makes the final decision.

Result	Certificate length	Basis
Meets the standards	Up to 24 months	Regulation (391.45)
Meets the standards, but a condition needs monitoring	Less than 24 months, set by the examiner	Examiner judgment
Insulin-treated diabetes	Up to 12 months, or up to 3 months without 3 months of glucose records	Regulation (391.46)
Alternative vision standard	Up to 12 months	Regulation (391.44, 391.45)
Blood pressure of 140-159/90-99 (stage 1)	May be 1 year	Guidance (Medical Advisory Criteria)
Blood pressure of 160-179/100-109 (stage 2)	May be a one-time 3 months to bring it to 140/90 or lower, then 1 year	Guidance (Medical Advisory Criteria)
Blood pressure of 180/110 or higher (stage 3)	Should not be certified until reduced to 140/90 or lower; then may be 6 months at a time	Guidance (Medical Advisory Criteria)
Determination pending	No new certificate yet; the driver has up to 45 days to provide information or complete testing	Regulation (391.43)
Does not meet the standards	No certificate; since June 23, 2025, any earlier certificates are no longer valid	Regulation (391.43, 391.45)

The last row matters to employers: a driver who fails a new exam cannot keep driving on an older, unexpired certificate.

How Do Employers Handle the Medical Certificate?

Employers must confirm a driver is medically certified before the driver operates a CMV and keep proof in the DQ file under 49 CFR 391.51. What counts as proof now depends on whether the driver holds a CDL or CLP.

What changed on June 23, 2025?

June 23, 2025 was the compliance date for FMCSA’s Medical Examiner’s Certification Integration rule, known as National Registry II (NRII). Examiners already report every DOT exam to the National Registry by midnight (local time) of the next calendar day. Under NRII, FMCSA now sends the results for CDL and CLP holders electronically to the state driver licensing agency (SDLA), which posts them to the driver’s record. According to FMCSA’s NRII Learning Center, that electronic record is now the official proof of medical certification. CDL and CLP holders no longer submit or carry a paper certificate, though FMCSA recommends examiners keep issuing one for now.

Question	CDL and CLP holders	Drivers who do not need a CDL
What is the official proof?	Medical certification status on the driver’s record from the current licensing state	The paper Medical Examiner’s Certificate, Form MCSA-5876
What goes in the DQ file?	The motor vehicle record from the current licensing state showing medical certification status	The certificate or a legible copy, plus a note verifying the examiner’s National Registry listing
Must the employer verify the examiner’s listing?	No, since June 23, 2025	Yes
Must the driver carry the certificate?	No, since June 23, 2025	Yes, the original or a copy, while on duty

Drivers who qualify through an FMCSA medical variance, such as an exemption or a Skill Performance Evaluation certificate, must still carry that document while on duty, and a copy belongs in the DQ file. If the electronic record and a paper certificate conflict, the electronic record controls.

A small number of states may still be completing the switch to NRII. For drivers licensed in a state that has not implemented it, FMCSA guidance recommends continuing the older paper process. FMCSA has also issued temporary exemptions during the transition that allowed limited reliance on a paper copy of the certificate. Check FMCSA’s NRII Learning Center for which states have implemented NRII and whether any exemption is currently in effect before relying on a paper copy.

Employer checklist for DOT medical certificates

1. Confirm the driver needs a physical. Compare the vehicle and the type of operation against the CMV definition above.
2. Send the driver to a listed examiner. Check the specific examiner on the National Registry search tool.
3. Get proof before the first trip. For CDL and CLP holders, obtain the motor vehicle record from the current licensing state and confirm it shows the driver as medically certified. For other drivers, get the certificate and record your verification of the examiner’s listing.
4. Record the actual expiration date. Do not assume 24 months. Track 3-month, 6-month and 12-month certificates.
5. Schedule renewals early. This leaves time to fix reporting errors.
6. Watch for mid-cycle triggers. An injury or illness that impairs a driver’s ability to do the job requires a new exam. A driver on insulin who has a severe low blood sugar episode must stop driving until cleared.
7. Act on a failed exam. A driver found not qualified cannot drive on an older certificate.
8. Keep the records. Keep each driver’s DQ file for the length of employment plus three years. Medical certificates and related motor vehicle records may be removed three years after they are issued.

How Does the DOT Physical Fit With Other Driver Checks?

The medical certificate shows only that a driver is physically qualified. Driving history, prior employer safety history and drug and alcohol testing are separate requirements, explained in the DOT background check overview. GoodHire offers motor vehicle record checks, and its drug testing page lists DOT drug tests.

Frequently Asked Questions

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