What does a DOT physical exam consist of
According to the US Department of Transportation (DOT), the most important safety feature of any commercial vehicle is the operator. This means drivers of trucks, buses, and other large vehicles on US public roads must be physically fit and fully capable of controlling these machines. Drivers prove this every two years by taking what is officially called the DOT Medical Exam and Commercial Motor Vehicle Certification, commonly known as the DOT physical.
If you are an operator of commercial motor vehicles (CMVs) hoping to get or renew your Commercial Driver’s License (CDL), this article will give you an overview of the DOT physical exam — what’s included and what you need to do to prepare and pass.
The DOT physical exam is required for certification to drive vehicles on US public roads that are over 10,000 lb gross weight, carry more than 15 people, or carry hazardous materials. The vast majority of people taking the test are therefore truck and bus drivers. The test takes around 45 minutes and must be taken every two years. (Some medical conditions require additional testing or more frequent testing.)
There are testing locations across the United States at medical practices, hospitals, and full-service transportation facilities along major highways. In some locations, mobile testing vehicles set up to provide extra capacity. Additionally, many transportation companies provide in-house testing for their employed drivers.
Testing is overseen by a division of the DOT known as the FMCSA (Federal Motor Carrier Safety Administration). The FMCSA certifies medical professionals across the US to perform the tests, certify the drivers, and report the results. Known as Certified Medical Examiners, they include doctors, chiropractors, and registered nurses. Some of them do DOT physicals on the side, while others specialize in the test and do it full time. You can learn more about the Certified Medical Examiners here.
The DOT physical evaluates vision, hearing, and balance, and looks for health conditions that could reduce your ability to control your vehicle. Potential disqualifying medical conditions include vision and hearing impairment, epilepsy or seizure disorders, uncontrolled hypertension, heart or respiratory conditions, diabetes, sleep disorders, psychiatric disorders, alcoholism, and drug abuse.
Drivers are assessed on an individual basis for their overall fitness for operating a CMV, so if you suffer from any of the above conditions, it does not necessarily mean you will fail the physical. Many drivers with a medical condition pass the physical and receive their license because they have the condition under control. This is known as receiving an exemption. We have another article that deep dives into DOT disqualifying medical conditions and their exemptions. You can check it out here.
Once the DOT physical is passed, certification lasts for 24 months and then you must undergo the test again. Certain medical conditions like heart disease, hypertension, and diabetes require an annual DOT physical.
The DOT physical exam ensures the safety of both you as a driver and the general road-going public. CMV operators are required to work long hours in a sitting position while maintaining concentration and handling stress. Sleep and eating may be disrupted. High levels of physical exertion may be required. All of these can be risk factors related to the safe operation of large vehicles. The DOT exam assesses whether you are able to safely tolerate these stresses — physically and mentally. Therefore, medical certification for commercial drivers must be taken very seriously.
Drivers should bring their current license(s) and another piece of photo identification. Also bring any prescription eyeglasses, contact lenses, hearing aids, or limb prosthetics. If you are taking prescription medication, bring any supporting documentation from your prescribing physician(s) and be able to provide their full names and contact details.
If you are currently exempted from any disqualifying condition, bring the documentation that supports your exemption. For example, amputees or those with other mobility issues should bring a valid FMCSA Skill Performance Evaluation Certificate. Diabetics should bring their most recent lab results.
Finally, as with any health checkup, wear loose-fitting clothes to facilitate the physical examination.
The FMCSA’s certified medical examiners follow standardized checklists, checking for specific conditions and capabilities. That said, the DOT physical is much like any general health checkup. The examiner will check your blood pressure and heart, your lungs and throat, and perform vision and hearing tests. In addition, you will undergo general neurological tests on your reflexes, dexterity, balance, and speech.
The DOT physical relies on urinalysis — you provide a urine sample during the test that will be screened for abnormal levels of proteins, blood, or sugar, any of which can indicate underlying health conditions. Note that the DOT physical urinalysis does not screen for drugs of any kind. Many employers mandate their own drug testing, but this is separate from the DOT physical exam procedures. The DOT physical exam does not require a blood test.
Here is the actual FMCSA Medical Examination Report Form. You can see the first section is completed by you, the driver, and surveys your general health history, any existing medical conditions, and any medication you are on. Note that this is all self-reporting, and withholding information or providing inaccurate or misleading information can invalidate your certification or even lead to criminal charges, so it is important to be honest in your answers. The second section is completed by the medical examiner, as with a typical health checkup.
If you do not have any disqualifying medical conditions, you will be issued a certificate, which you should keep in your driver qualification file.
The DOT physical exam tests for two of the most common health problems in the US: diabetes and hypertension (high blood pressure). Indicators of these (and other) health conditions will appear in your urine sample, but it is relatively easy to take a few steps to reduce these indicators before your test.
The most common advice is to reduce your intake of salt, sugar, nicotine, and caffeine in the 48 hours before the test. Also, drink a lot of water to stay as hydrated as possible in the 24 hours before the test. These actions will ensure that the water volume of your urine is high and the concentration of any indicators is low.
It is also advisable to sleep as well as possible in the 48 hours before the test. This, in addition to the reduction of nicotine, caffeine, and sodium, should keep your blood pressure low during the test. And, of course, prepare your documents in advance and give yourself plenty of time to get to the test — anything to avoid rushing around and raising stress (and therefore blood pressure) levels.
Finally, it is important to be as transparent as possible in the exam, and answer questions completely. Much of the test involves self-reporting past or existing medical conditions, and while it may be tempting to simply not mention something, the penalty for nondisclosure or providing misleading information can be severe, ranging from the loss of one’s license to criminal charges.
Not if you are in good physical and mental health. You need normal healthy vision, hearing, and mobility, and you need to be free from debilitating medical conditions that prevent you from safely operating a motor vehicle for long periods of time.
In addition, there are multiple exemptions for existing medical conditions, provided you can show that they are corrected (for example, with eye glasses or limb prosthetics) or controlled (for example, with medication).
The exam is required every two years, unless you have applied for a medical exemption or have a potential DOT disqualifying medical condition, in which case it may be every 12 months or less.
While the procedures vary by state, yes, a valid FMCSA medical certificate is required to maintain a commercial driver’s license.
The exam is performed by doctors, nurses, and other medical professionals certified by the FMCSA and listed in the National Registry of Certified Medical Examiners (NRCME).
As discussed in the main article above, the medical examiner may not certify you if you have a DOT disqualifying medical condition. However, many conditions are assessed based on the individual and the subjective medical judgment of the examiner. In addition, objective medical disqualifications can sometimes be reversed through exemptions granted by the FMCSA. For a more detailed look at exemptions, check out our article here.
This depends on whether your disqualifying medical condition is permanent. Medical disqualifications can be reassessed if your condition improves or becomes controlled through treatment.
Potential disqualifying medical conditions include vision or hearing impairment, epilepsy or seizure disorders, fainting spells, uncontrolled hypertension, heart or respiratory conditions, diabetes, sleep disorders, psychiatric disorders, alcoholism, and drug abuse. As explained in the article above, the majority of these are assessed based on the overall capabilities of the individual, so if you suffer from any of these conditions, it does not necessarily mean you will fail the physical.
If you have stage 3 hypertension (BP higher than 180/110), you are considered high risk and will fail the DOT physical. You can retest if you reach a stable 140/90.
Those with stage 2 hypertension (160–179 systolic and/or 100–109 diastolic) may be given a one-time certification of three months, during which if they reduce their BP to 140/90, they may be granted a 12-month certification.
If you have stage 1 hypertension (140–159 systolic and/or 90–99 diastolic), you may be certified for a 12-month period.
Previously, diabetes was a blanket DOT disqualifying medical condition. Standards were revised in 2018 to permit insulin use for diabetic CMV drivers, provided medical recertification is acquired every 12 months and certain physical requirements, such as visual acuity, are met.
Not if corrected to a specific level with glasses or contact lenses. To pass the physical, you are required to have 20/40 vision in each eye and both eyes together, with or without glasses or contacts, and a field of vision of at least 70 degrees in both eyes. If you are unable to meet these levels, then impaired vision is a disqualifying medical condition and you will fail the test.
Color blindness is also an issue: You must be able to distinguish traffic signal colors (red, green, and amber).
If you are unsure whether you meet the above requirements, you should obtain a Vision Evaluation Report from a licensed ophthalmologist or optometrist covering visual acuity, field of vision, and recognition of colors prior to your DOT physical and bring this document with you to the test.
Yes, the medical examiner will perform an abdominal examination for hernias, and any current or past hernias should be self-reported in the first part of the FMCSA Medical Examination Report Form.
Yes, if corrected with prosthetics or other means and demonstrated by receiving a Skill Performance Evaluation Certificate from the FMCSA. This will show that you have no limiting mobility or dexterity issues, and are able to drive CMVs across state lines.
No, and the urinalysis does not screen for any legal or illegal drugs. However, in the self-reporting section, you need to answer the question, Have you used an illegal substance within the past two years? Depending on the state where cannabis use occured, this could create an issue for the user.