Alliance Insurance Group Driver Qualification Basics for Senior Living Vehicles

Transcription

1 Alliance Insurance Group 2016 Driver Qualification Basics for Senior Living Vehicles

2 Driver Qualification Basics Passenger Vehicles Table of Contents Understanding the FMCSR Rules and Regulations of Driver qualification for Motor Carriers. Commercial Motor Vehicle ( 390.5)...3 CDL License Class Descriptions & Endorsement...3 State Compliance w/ CDL Program ( 384)...3 Medical Qualification of Drivers ( 391)...4 Hours of Service 49 CFR, ( 395)...4 Drug and Alcohol Testing ( 382)...5 CMV Driver Basics ( )...6 Drug and Alcohol Awareness Training...6 Substance Abuse Professional (SAP)...7 California Pull Notices...7 Safe Driver Recognition...7 Commercial Bus DQ File Components...8 Non Commercial Bus DQ file Components Company Car Driver File Components Page 2 of 14

3 Driver Qualification Basics Passenger Vehicles Understanding the FMCSR Rules and Regulations of Driver qualification for Motor Carriers. Commercial Motor Vehicle ( 390.5) Commercial motor vehicle any self propelled or towed motor vehicle used on a highway in interstate commerce to transport passengers or property when the vehicle (1) Has a gross vehicle weight rating or gross combination weight rating, or gross vehicle weight or gross combination weight, of 4,536 kg (10,001 pounds) or more, whichever is greater; or (2) Is designed or used to transport more than 8 passengers (including the driver) for compensation; or (3) Is designed or used to transport more than 15 passengers, including the driver, and is not used to transport passengers for compensation; or (4) Is used in transporting material found by the Secretary of Transportation to be hazardous under 49 U.S.C and transported in a quantity requiring placarding under regulations prescribed by the Secretary under 49 CFR, subtitle B, chapter I, subchapter C. **California CMV = designed to hold 10+ passengers including the driver CDL License Class Descriptions & Endorsement Class A: Any combination of vehicles which has a gross combination weight rating or gross combination weight of 11,794 kilograms or more (26,001 pounds or more) whichever is greater, inclusive of a towed unit(s) with a gross vehicle weight rating or gross vehicle weight of more than 4,536 kilograms (10,000 pounds) whichever is greater. Class B: Any single vehicle which has a gross vehicle weight rating or gross vehicle weight of 11,794 or more kilograms (26,001 pounds or more), or any such vehicle towing a vehicle with a gross vehicle weight rating or gross vehicle weight that does not exceed 4,536 kilograms (10,000 pounds). Class C: Any single vehicle, or combination of vehicles, that does not meet the definition of Class A or Class B, but is either designed to transport 16 or more passengers, including the driver, or is transporting material that has been designated as hazardous under 49 U.S.C and is required to be placarded under subpart F of 49 CFR Part 172 or is transporting any quantity of a material listed as a select agent or toxin in 42 CFR Part 73. Passenger Endorsement (P) required for CDL licenses when operating Passenger transport vehicles. Contact Connecticut DMV for additional passenger carrying endorsement rules. *CA Class B with P endorsement required to operate any bus *TX Class B with P endorsement required for 24 passengers or more including driver State Compliance w/ CDL Program ( 384) Each State must authorize a person to operate a CMV only by issuance of a CLP (learner permit) or CDL. The State may not issue, upgrade or transfer a CDL to a person unless that person surrenders any prior driver license or CLP. Only 1 driver license is valid at any time and must be of the State of Domicile. Page 3 of 14

4 Driver Qualification Basics Passenger Vehicles Medical Qualification of Drivers ( 391) *DOT Medical Certificate Interstate vs. Intrastate If a driver performs trade, traffic, or transportation exclusively in his/her business s domicile state, this is considered intrastate commerce. If a driver s trade, traffic, or transportation is between a place in a state and a place outside of such state (including a place outside of the United States); between two places in a state through another state or a place outside of the United States; or between two places in a state as part of trade, traffic, or transportation originating or terminating outside the state or the United States, this is considered interstate commerce. Source: 49 CFR By January 30, 2014, all CDL holders were required to self certify with their state licensing agency the type of commerce they drive in as well as their medical status. The selected commerce will appear on the CDL holder s MVR and can be changed at any time by the driver based on the purpose of their driving. The CDL holders were given four choices to choose from: Non Excepted Interstate Excepted Interstate Non Excepted Intrastate Excepted Intrastate Depending on the state rules, the state may require the DOT medical certificate to be turned into the licensing agency. A motor carrier must verify on the driver record that the CDL holder has self certified and that their medical status is updated with the state each time a DOT medical certificate is issued to the driver. Effective May 21, 2014, FMCSA required all medical examiners (ME) that perform DOT physicals for Interstate CMV drivers, be certified and to register in the (NRCME) National Registry of Certified Medical Examiners. Visit the FMCSA website to ensure your required drivers are issued a certificate by a valid ME: Effective April 20, 2016, FMCSA required mandatory use of MCSA 5875 Medical Examination Report and Form MCSA 5876 Medical Certificate. Reports and Certificates not issued on the new forms as described, are not valid. *CDL drivers are required to carry Medical card until June 22, Which at that time the ME will report results of exam by midnight of next calendar day. Motor Carrier then confirms on MVR proof of medical status. *Non CMV drivers are required to continue to carry Medical card while driving as they do not hold a CDL. Hours of Service 49 CFR, 395 Time Keeping Requirements Department of Transportation (DOT) Regulations require all commercial drivers to follow the Hours of Service (HOS) Requirements for passenger carrying vehicles via Driver s Daily Logbook (Time Record). The HOS rules help to reduce driver fatigue and avoid DOT penalties. On Duty Hours: 10 Hour Driving Rule A driver cannot drive for more than 10 hours following 8 consecutive hours off duty. All time spent at the driving controls of a commercial motor vehicle is considered driving time. 15 Hour On Duty Rule A driver cannot drive after having been on duty for a total of 15 hours. After 15 hours on duty, a driver cannot drive again until he/she has 8 consecutive hours of rest. 60 Hour/7 Day Limit A driver cannot drive after having been on duty for 60 hours in any 7 Page 4 of 14

5 Driver Qualification Basics Passenger Vehicles consecutive days. On Duty Time is defined as all time from the time a driver begins to work until the time he/she is relieved from work and all work responsibility. Work for any entity is considered on duty time. CMV Drivers that meet the 100 Air Mile Radius Exemption and are exempt from completing a Driver s Daily Logbook, all on and off duty time can be recorded via your payroll records. 100 Air Mile Radius Exemption The driver operates within a 100 airmile radius (equivalent to statute miles) of the normal work reporting l ocation; The driver returns to his/her work reporting location and is released from work within 12 consecutive hours; At least 8 consecutive hours off duty separate each 12 hours on duty; The driver does not drive more than 10 hours following 8 hours off duty; The motor carrier that employs the driver maintains and retains for a period of 6 months accurate and true time records showing: start time each day, end time ea ch day, total time on duty each day and 7 days prior time onduty for intermittent drivers. First time and Intermittent CMV Drivers Drivers used for the first time as well as intermittently, must complete a signed statement giving the total time on duty during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to beginning work for the motor carrier. Multiple Employer CMV Drivers must maintain current time records from all employers in their driver file via Driver s Daily Logbook. Records are to be kept for six (6) months. Penalties may include the driver and/or vehicle being placed out of service, state and/or local fines, civil and/or criminal penalties and the downgrade of the company s safety rating. Drug and Alcohol Testing ( 382) 49 CFR part 40 All CDL holders operating a CMV are subject to DOT Drug and Alcohol testing and must be enrolled into a consortium or company managed DOT drug and alcohol testing program. To treat all of your bus drivers the same, your Non CMV bus drivers may be tested as noted below. Commercial drivers: DOT Regulated pre employment, random, reasonable suspicion (if Positive, employer must refer driver to Substance Abuse Professional (SAP) and complete substance abuse program, then may be subject to return to duty and follow up tests as suggested by SAP) Non commercial bus drivers: non DOT regulated pre employment, non regulated reasonable suspicion (based on company policy) Description of the types of testing are listed below: Pre Employment Drug Test the first test prior to performing a safety sensitive function. The employer can choose whether or not to Breath Alcohol Test for preemployment purposes but must be consistent with the requirement for all new drivers. Post Accident Drug and Alcohol testing required as soon as possible when either of the following criteria are met: i) Human Fatality Page 5 of 14

6 Driver Qualification Basics Passenger Vehicles ii) Driver receives a Citation and there is bodily injury with immediate medical treatment away from the scene iii) Driver receives a Citation and there is disabling damage to any motor vehicle requiring tow away Required Training for Supervisors Random The required number of CDL drivers required to be tested throughout a calendar year, is the following: o The minimum annual percentage rate for random alcohol testing is 10% of the average number of driver positions and 25% for controlled substances testing. Once the driver is notified of testing, driver must complete the test within 2 hours for Alcohol testing and 24 hours for drug testing. Driver must be on duty and not called in just to take the test. Set test aside if driver is on leave of absence or an intermittent driver and administer upon return. Reasonable Suspicion An employer may require a driver to submit to an alcohol or drug test when the employer has reasonable suspicion to believe the driver has violated the prohibitions of Subpart B. Per only the trained Supervisor or company official may do the required observation and must articulate the specific behaviors to support testing. If suspected, driver must be removed from all driver related job functions, provided with transportation to testing as well as home and waits for negative drug results prior to returning to work. Per Federal Regulations, the employer must ensure the supervisors of drivers receive at least 60 minutes of training on alcohol misuse and an additional 60 minutes of training on controlled substances use. For Non Commercial Reasonable Suspicion, this is based on your Company policy. If company policy enforced you must use nonregulated drug and/or alcohol forms. Return to Duty After a driver has violated a DOT Drug or Alcohol regulation, the driver must undergo treatment by a Substance Abuse Professional (SAP) and must comply with the recommendations by the SAP in order to be considered eligible to return to duty. An employer must make sure before they allow the driver to return to a safety sensitive position, that the driver undergoes either a return to duty alcohol test with a result indicating an alcohol concentration of less than.02 or a negative result for a controlled substance test. Follow up testing Based on the SAP s evaluation, the driver may be subject to unannounced follow up drug or alcohol testing. Completion of the testing must be at the direction of the SAP professional. If follow up alcohol testing is required, it shall be conducted only just before, during or after a safety sensitive function. CMV Entry Level Driver Training (CMV Driver Basics) ( ) This is required by Federal Regulations for any driver who has had a CDL for less than 12 months. Training includes Qualification Requirements, Hours of Service, Driver Wellness, and Whistle Blower Protection. The driver qualification process helps determine if this training is required. Drug and Alcohol Awareness Training Drug and Alcohol Driver Awareness Training is required for every person who operates a CMV in interstate or intrastate commerce in the U.S., and is subject to the CDL requirements. Best practice is to treat all of your Bus drivers the same and to require this training for Non CMV Bus drivers as well. Training will include who is covered by the Alcohol and Drug Regulations; the prohibitions, required testing, consequences of violation Page 6 of 14

7 Driver Qualification Basics Passenger Vehicles the prohibitions, the effects of Drug and Alcohol and where to go for help. Substance Abuse Professional California Pull Notices Commercial drivers are subject to all Federal drug and alcohol regulations. If a driver has violated these (prohibited behavior), they are no longer eligible to drive and must be notified of the Substance Abuse Program. The employer is neither required to maintain employment or pay for the program. Company policy may terminate a driver who has violated a drug or alcohol regulation. To drive again commercially for any company, a driver must complete the SAP program if: Applicant has a drug/alcohol violation with a previous employer; Current driver fails or refuses a drug/alcohol test; Any driver/applicant whose MVR reflects a DUI (or similar) within 3 year period and who have not completed an SAP already for that violation. The Pull Notice program is California MVR s. Contact the CA DMV to get enrolled and receive a Requester Code for your Company. Enroll as required, each commercial driver with a California CDL driving in CA in the CA Pull Notice Program upon qualification to drive. Keep a copy of the driver Pull Notice in the DQ file. Delete the driver from the program upon termination or no longer driving. The motor carrier is audited by the California Highway Patrol (CHP) on a regular basis and must provide a current pull notice for each active driver. The state will provide a Pull Notice upon enrollment, upon occurrence of a conviction or accident and when a medical card is about to expire. Safe Driver Recognition Based on criteria set forth by your company, establish a Safe Driver Program to recognize your safe drivers. Award and acknowledge your eligible drivers to show your appreciation for their day to day safe operation and handling of your vehicles. Page 7 of 14

8 Driver Qualification Basics Passenger Vehicles Commercial Bus DQ file components Motor carriers must maintain a driver qualification (DQ) file for each driver it employs. A DQ file may be combined with his/her personnel file. When an associate or applicant is in process to get qualified to drive, create a check list to track their progress. Prior to providing authorization to drive, ensure all components are completed as required to eliminate potential for DOT violations in the event of a DOT audit. Section ( ) (391.11) (391.43) PRE EMPLOYMENT DOT REGULATED DRUG TEST The first test is always pre employment, regardless of employment status. Negative Results must be kept for 3years while Positive Results must be kept for 5 years. o Every commercial driver applicant must take a pre employment drug screen. Possible Exception: drivers currently employed elsewhere and enrolled in a drug program may request current employer to provide proof of this exemption. (This only exempts pre employment test, not a random test). The proof requires specific drug test information from current employer per Subpart C File the drug form and drug results in the DQ file. COMMERCIAL DRIVER S LICENSE The process occurs in stages for those that don t already have their CDL. Copies of current and any renewed license must be kept in DQ file for duration of employment. o PERMIT LICENSE First time CDL (or when adding P endorsement) Applicant takes DMV written exam and is issued a CDL learners permit, CDL instruction permit, temporary permit, or learner license with proper restriction. Must say CDL or Commercial Driver s License or have the proper restriction added indicating authorization to practice driving a CMV. Should have P endorsement ( I for instruction permit in WA state) ( P restriction in TX for LOFS or over Bus only) Permit legally allows practice driving the bus with licensed CDL driver, but must qualify as permit driver before practice driving. o TEMPORARY LICENSE Paper copy issued after passing DMV driving test It is a valid license, but only good for a few months It must say Commercial Driver s License or CDL It must be P endorsed. See CT for S, V, A or F endorsement. Temp license must be provided to qualify to drive alone o PERMANENT LICENSE Final version of CDL Must have valid expiration date Must have P endorsement. See CT for S,V,A or F endorsement Must say Commercial Driver s License or CDL Permanent license must be provided to replace temporary license MEDICAL CERTIFICATE The medical certificate is provided upon successful completion of a DOT physical and must be kept on file for three years. o DOT Physical must be performed by an ME listed on the National Registry as described above. o DOT physical is valid 1, 2 or 3 months to 2 years depending on driver s health. o Medical Certificate MUST have doctors name, address, phone number, operating license and driver s name, address, license #, certificate issue date and expiration date and national registry number. Motor Carrier must verify and document that Page 8 of 14

9 Driver Qualification Basics Passenger Vehicles the ME is listed on the National Registry. (391.21) (391.23) DRIVER S APPLICATION FOR EMPLOYMENT Must be completed and signed Per section prior to operating a CMV and regardless if held CDL before. The document must be kept on file for duration of employment and include the following information: o Past Addresses must show every address for 3 years & how long at each Employer must order Motor Vehicle Report from each state had driver s license in past 3 years o Employment should only list employers driven CMV for in past 10 years CRITICAL NOTE: if any of those employers were in the past 3 years, a Safety Performance History inquiry must be conducted. o Accident Record must show last 3 years history Compare information to MVR to look for discrepancies If preventable accident for example appears on MVR but is not on Application or Certification of Violations, it is considered non disclosure and based on your company policy, the applicant may be placed on probation at time of qualification for a timeframe at your company s discretion. Create generic warning letters to be issued when necessary. o Traffic Convictions must show last 3 years history Compare information to MVR If conviction is on MVR for example but is not on Application or COV, it is considered non disclosure and based on your company policy, the applicant may be placed on probation at time of qualification for a timeframe at your company s discretion. Create generic warning letters to be issued when necessary for any driver applicant. Example of company discretion: o o If 2 convictions (or 1 conviction & 1 preventable accident) in 3 years, driver is placed on warning until the 1st item goes away plus 6 months for nondisclosure. If 3 items in 3 years, may not qualify. Driver s Licenses must show all licenses (regular and commercial) from all states held within past 3 years Use license number & state to order previous states MVR s. If license number not listed, order per state rules. If driver held a CDL previously for at least 12 consecutive months, the driver is exempt from completing CMV Driver Basics (Entry Level Training). Driving Experience more detail helps determine if additional CMV Entry Level Driver Training is necessary License Denied? When and why? Critical to note if within the past 3 years and take appropriate action (revoked/not qualified/etc.) License Suspended? When and why? Critical to note if within the past 3 years and take appropriate action (revoked/not qualified/etc.) PREVIOUS EMPLOYER SAFETY PERFORMANCE HISTORY Employer must inquire with all employers applicant has driven a CMV or subject to FMCSR s in past 3 years. Documentation of attempts to inquire as well as completion must be kept on file for the duration of employment. o Employer must obtain written consent from applicant prior to inquiry. o Record each attempt and how it was attempted. o Employer can /fax/mail or call previous employer directly upon receipt: Page 9 of 14

10 Driver Qualification Basics Passenger Vehicles Review for alcohol/drug violations and DOT recordable accidents. D If all answers are NO Write verified ok on correspondence, add signature and date. D If an answer is YES (violations exist), determine if you should pursue qualification per your company policy. Drug/Alcohol violations require completion of an SAP program before driving CMV again. NO EXCEPTIONS. Review accident history with applicant s COV, MVR and Driver Application for disclosure and safe driving. On form write verified, add signature and date (391.25) and (391.27) (383.21) ( ) Federal Motor Carrier Safety Regulations RECORD OF VIOLATIONS / ANNUAL REVIEW OF DRIVING RECORD Except as provided in Subpart G of this part, each motor carrier shall, at least once every 12 months (at time of qualification and yearly thereafter): o Require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted or on account of which he/she has forfeited bond or collateral during the preceding 12 months. o Make an inquiry to obtain the motor vehicle record of each driver it employs that includes the preceding 12 months to determine if that driver meets the minimum requirements for safe driving or is disqualified to drive a CMV according to and your company policy. o The motor carrier shall create the form that the applicant must certify. o Motor carrier must note on the form the name of the person who performed the review and the date of the review. o Initial MVR must be kept on file for duration of employment. o Annual form and corresponding MVR must be kept on file for 3 years. CERTIFICATE OF COMPLIANCE Applicant must sign and date that they acknowledge the following: o Driver may not possess more than one current valid driver s license o Driver shall surrender the driver s license from the old state of domicile to the new state of domicile after establishing domicile and within the state s new residency license rules. DRUG AND ALCOHOL POLICY RECEIPT To comply with the regulations, the company must have a Drug and Alcohol Policy and the employer must require that each driver sign and date a statement certifying that he or she has received a copy of the employer s policy on the misuse of alcohol and use of controlled substances as described in Subpart F of Signed statement must be kept on file for duration of employment. o Employer would be in violation if a driver is used that refused to comply with to perform a safety sensitive position as is a requirement required of the employer. FMCSR DRIVER S RECEIPT Employer shall require that each driver sign and date a receipt acknowledging receipt of the Federal Motor Carrier Safety Regulations. Receipt must be kept on file duration of employment. o Employer to provide regulations via Pocket Book or Electronic Version availability. Page 10 of 14

11 Driver Qualification Basics Passenger Vehicles State Specific WASHINGTON MVR AUTHORIZATION FORM Form available on DOL website. Form is required for all Washington State driver s licenses. Must have signed form prior to ordering WA MVR. Form is to be kept on file for duration of employment. o Driver signs & dates form. o Reviewer orders and reviews MVR and signs and dates form. CALIFORNIA PROFICIENCY AND AUTHORIZED VEHICLES FORM Only for California commercial drivers per 13 CCR. Employer must complete form after applicant has been qualified to drive and while witnessing drivers operate bus. Form is required / requested by California Highway Patrol officers during a bus audit and should be kept on file for duration of employment. o 13 CCR 1229 Motor Carriers shall require each driver to demonstrate that the driver is capable of safely operating each different type of vehicle or vehicle combination (i.e., vehicles with different controls, gauges, of different size, or requiring different driving skills) before driving such vehicle(s) on a highway unsupervised. The driver s capability to operate the vehicle shall include special equipment such as wheelchair lifts, ramps, or wheelchair tie downs. This Section shall not apply to a motor carrier who is the owner and sole driver of a vehicle or combination of vehicles. o 13 CCR 1234 Driver s Authorized Vehicles. Motor carriers shall maintain a record of the different types of vehicles and vehicle combinations each driver is capable of driving as specified in Section (395.8) (J) (2) (391.23) (a)(1) DRIVERS RECORD OF DUTY STATUS First time and intermittent drivers must report the total time on duty during the immediately preceding 7 days and the time they were last relieved from duty prior to working for the new motor carrier. Initial form must be kept on file for duration of employment. All subsequent forms/logs can be kept for six month. o Total hours worked in past 7 days cannot exceed 60 hours. If hours exceed, the driver cannot drive CMV until days go by without working to eliminate hours. o If driver works for or plans to work for other employers, they must submit additional time records from other employers each time they driver for you and may do so via a Drivers Time Record Log book. These records are kept for 6 months for audit purposes. MVR (MOTOR VEHICLE REPORT/RECORD) The MVR must be a state issued driving record from each required state that a driver held a license during the previous 3 years. The driving record and documentation of motor carrier s efforts to obtain required records must be on file within 30 days of employment date. Regulations also require an MVR for each driver every 12 months, covering the previous 12 months. See Record of Violations/ Annual Review of Driving record above. Upon satisfactory review and completion of all documents and motor carrier receives a verified negative drug result, the driver applicant is then eligible to get behind the wheel of a CMV. Motor carrier must ensure receipt of current Driver License, DOT medical certificate and Page 11 of 14

12 Driver Qualification Basics Passenger Vehicles Yearly Certification of Violations form with review of current MVR prior to expiration of each document to continue qualification of the driver. State Specific Follow up CALIFORNIA PULL NOTICE PROGRAM Every California commercial driver must be enrolled in the PULL NOTICE Program. See Section above. Page 12 of 14

13 Driver Qualification Basics Passenger Vehicles Non Commercial Bus DQ file components Per company policy, Non commercial bus drivers may be qualified on similar standards to that of a commercial driver. For smaller, non commercial buses (designed to hold 5 15 passenger or 5 9 California), have the applicant complete non commercial driver paperwork prior to authorization. Require a Non DOT pre employment drug test and DOT medical certificate from a DOT physical. PRE EMPLOYMENT DRUG TEST (NON DOT) Test is classified as pre employment regardless of employment status. DOT MEDICAL CERTIFICATE Employer can use same medical requirements as commercial bus drivers to ensure the same physical health standards apply. DRIVER APPLICATION FOR EMPLOYMENT ADDENDUM (NON DOT) Listing all addresses/license for past 3 years, any accidents, convictions, driver s licenses in past 3 years and any driving experience. DRUG & ALCOHOL POLICY RECEIPT COPY OF LICENSE a copy of the front and back of the regular license. RECORD OF VIOLATIONS (NON DOT) Must show any convictions or accidents in the past 12 months. VERIFICATION OF TRAINING Alcohol & Drug Awareness Training. MVR order and compare to Driver Application and COV for safe driving history. Upon satisfactory review and completion of all documents and motor carrier receives a verified negative drug result, the applicant is then eligible to get behind the wheel. Motor carrier must ensure receipt of current Driver License, DOT medical certificate and Yearly Certification of Violations form with review of the current MVR prior to expiration of each document to continue qualification of the driver. Page 13 of 14

14 Driver Qualification Basics Passenger Vehicles Company Car File Components For vehicles designed to carry 4 passengers, after reading company policies have the applicant sign a consent form authorizing the employer to run an MVR. Keep all MVR s filed for the duration of employment. Upon satisfactory review of the MVR, the applicant is then eligible to get behind the wheel. Motor carrier must ensure that every 12 months a new Motor Vehicle report is ordered and reviewed for continued eligibility of the driver. Page 14 of 14

15 Driver s License Request A copy of the driver s current CDL license and any renewed licenses thereafter must be kept in the DQ file for the duration of employment. Please use the example below of how a copy of the Driver s License should be kept on file. Front of Driver s License Back of Driver s License

16 Sample Medical Certificate Effective May 21, 2014, per FMCSA, all doctors that perform DOT Physicals for Interstate Commercial drivers will require certification and registration in the National Registry of Certified Medical Examiners (NRCME). Failure to comply will result in the Medical Certificate not being accepted by the motor carrier. The motor carrier must verify the national registry number when reviewing a completed certificate from a driver and must note the date of review along with the reviewer s name. The driver is required to keep the certificate with them at all times while driving a commercial vehicle. The DOT website to locate a certified medical examiner (ME) closest to you is below: Beginning April 20, 2016, ME s must use the new Medical Certificate Form (MCSA 5876). See sample below. SAMPLE MEDICAL EXAMINERS CERTIFICATE

17 Certification of Violations / Annual Review of Driving Record Each motor carrier shall at least once every 12 months, require each driver it employs to complete and submit a list of violations as required by FMCSR Information provided by drivers on previous convictions, does not need to be repeated on this form. COMPLETED BY DRIVER CERTIFICATION OF VIOLATIONS DRIVER INSTRUCTIONS: Complete information below. Write in any violations or check None box if applicable and sign and date. EMPLOYER STATE NAME OF DRIVER: (PRINT) SOCIAL SECURITY NUMBER CURRENT RESIDENCE ADDRESS DRIVER S LICENSE NUMBER STATE EXP DATE CITY STATE I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months. DATE OF CONVICTION OFFENSE LOCATION TYPE OF VEHICLE OPERATED D None If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months. Driver s Signature: *Conviction means an un vacated adjudication of guilt, or a determination that a person has violated or failed to comply with the law in a court of original jurisdiction or by an authorized administrative tribunal, an unvacated forfeiture of bail or collateral deposited to secure the person's appearance in court, a plea of guilty or nolo contendere accepted by the court, the payment of a fine or court cost, or violation of a condition of release without bail, regardless of whether or not the penalty is rebated, suspended, or probated." Date: COMPLETED BY REVIEWER ANNUAL REVIEW OF MVR MOTOR CARRIER INSTRUCTIONS: Review the Certification of Violations listed above and driver s annual MVR and other information described in FMCSR Complete the information requested below. I have reviewed the driving record and find that he/she (check one): D Meets minimum requirements for safe driving Notes: D Is disqualified to drive a motor vehicle Action taken: Company Name Address Confidential Fax Signature of Reviewer Title Date 1 FMCSR Part Record of Violations. (b)each driver shall furnish the list required in accordance with paragraph (a) of this section. If the driver has not been convicted of, or forfeited bond or collateral on account of, any violation, which must be listed, he/she shall so certify. (e)drivers who have provided information required by of this subchapter need not repeat that information in the annual list of violations. 2 FMCSR Part (c)(2) Disqualifying Offenses. (c)(2)(i ) Driving a commercial motor vehicle while under the influence of alcohol. (c)(2)(ii) Driving a commercial motor vehicle under the influence of controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug; (c)(2)(iii) Transportation, possession, or unlawful use of a controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs; (c)(2)(iv) Leaving the scene of an accident while operating a commercial motor vehicle; or (c)(2)(v) A felony involving the use of a commercial motor vehicle

18 Driver Application Complete ALL sections in PRINT. Read and answer all questions completely. Only signed and dated forms can be accepted. Employer Name: Name (Last, First, Middle): Social Security Number: Date of Birth: List your addresses of residency for the past 3 years. Street City State Zip How Long? Current Address: Street City State Zip How Long? Previous Address: Street City State Zip How Long? Previous Address: Street City State Zip How Long? Previous Address: Have you ever been employed by Enter Company Name? D NO DYES Is there any reason you may be unable to perform the functions of the job? D NO D YES, explain: Employment Commercial Motor Vehicle (CMV) Driver Provide employer information for companies you drove a CMV for in the past 10 years. Complete all fields. (List most recent employers first. Add another sheet if necessary). Company Name Name & Title of Immediate Supervisor Telephone Address City State Zip Position Reason for leaving Date of Employment (month/year) From: To: Y Subject to the FMCSRs? D No D Yes Y Subject to DOT regulated alcohol and controlled substances testing? D No D Yes If employed within past 3 years, you MUST complete a Driver History Request Form for this Employer Company Name Name & Title of Immediate Supervisor Telephone Address City State Zip Position Reason for leaving Date of Employment (month/year) From: To: Y Subject to the FMCSRs? D No D Yes Y Subject to DOT regulated alcohol and controlled substances testing? D No D Yes If employed within past 3 years, you MUST complete a Driver History Request Form for this Employer Company Name Name & Title of Immediate Supervisor Telephone Address City State Zip Position Reason for leaving Date of Employment (month/year) From: To: Y Subject to the FMCSRs? D No D Yes Y Subject to DOT regulated alcohol and controlled substances testing? D No D Yes If employed within past 3 years, you MUST complete a Driver History Request Form for this Employer

19 Accident Record for past 3 years. If None, Check Here: D None DATE NATURE OF ACCIDENT (REAR END, BACKING, ETC.) TOWED INJURED FATALITY LAST ACCIDENT NEXT PREVIOUS NEXT PREVIOUS Traffic Convictions and Forfeitures for past 3 years (other than parking violations) If None, Check Here: D None LOCATION (CITY, STATE) DATE CHARGE PENALTY Driving Experience If None, Check Here: D None CLASS OF EQUIPMENT TYPE OF EQUIPMENT (van, tank, flat, etc) FROM DATES TO APPROX. NO. OF MILES (TOTAL) STRAIGHT TRUCK/ SEMI TRAILER/ 2 TRAILERS MOTORCOACH BUS SCHOOL BUS OTHER: List States operated in for last five years: List special courses or training: List safe driving awards and whom from: List any trucking, transportation or other experience: List any other special equipment or technical materials you can work with: Drivers Licenses held in past 3 years (required to order MVR s from each state) ISSUING LICENSE NO. STATE DRIVER S LICENSES CDL/ NON CDL TYPE (i.e. A,B,C) ENDORSED (i.e. P) EXPIRATION DATE A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? D NO D YES please describe: B. Has any license, permit or privilege ever been suspended or revoked? D NO D YES complete the following: Revoked/Suspended Date: Reason: Driver's License Number: State: To Be Read and Signed By Applicant This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my previous employment, previous drug and alcohol test results, medical history or driving record and other related matters as may be necessary in arriving at an employment decision. 1 2 I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. Applicant s Signature Date 1 The Federal Motor Carrier Safety Regulations stipulate that to drive a Commercial Motor Vehicle (CMV) (which is any vehicle of gross combination or vehicle weight of 26,001 lbs OR designed to carry 16 passengers including driver) a Commercial Drivers License (CDL) must be obtained. Additionally, to carry passengers a Passenger ( P ) Endorsement must be added to the CDL. This Federal Law applies to all U.S. States. However, some states may require ADDITIONAL regulations that must also be followed (i.e. California stipulates that a CMV is any vehicle designed to carry 10 passengers including driver). 2 To comply with FMCSR s motor carriers are required to obtain information from past employers in regards to employment history, previous drug & alcohol test results, and previous motor vehicle reports (MVR). To remain in compliance, all drivers must be automatically enrolled in a random drug selection process and an MVR obtained annually. In addition, each driver must complete an Annual Certification of Violations which will be compared to the annual MVR. Discrepancies could influence qualifications to drive. 2

20 Company Name: Printed Name of reviewer: Title: D 1 st request D Phone D Fax D Mail Request Date: Comments: Signature: Date: D 2 nd request D Phone D Fax D Mail Request Date: Comments: Signature: Date: D Notify FMCSA of Non Response Previous Employer Safety Performance History Request Complete one form for each employer applicant drove a CMV for during the previous 3 years COMPLETED BY APPLICANT Previous Employer Contact Name Phone Address City State Zip I hereby authorize the previous employer to release the requested information to the prospective employer for the purposes of investigation as required by Section 40.25, , and allowed by Section of the Federal Motor Carrier Safety Regulations. I release all parties noted herein from any and all liability, which may result from furnishing such information. Applicant s Printed Name Applicant s Signature Social Security Number Date Prospective Employer Contact, Title Confidential Fax. Address Direst Phone COMPLETED BY PREVIOUS EMPLOYER If applicant drove a commercial motor vehicle for your company or was in a safety sensitive function that required alcohol and controlled substance testing specified by FMSCR 49 CFR part 40, you are REQUIRED by Federal regulations (Part ) to provide this information. Your reply is completely confidential. Thank you. 1. Did the applicant drive a CMV or was in a DOT regulated position? D NO please sign, date and fax this form to: Enter Fax # to Return form to D YES [to either question] you are required by federal regulations to complete this form Select all that apply: D Passenger car D Bus D Straight truck D Tractor/Semi trailer D Other: 2. Employed: From To Position: 3. Was employee in a DOT accident? D NO DYES... Date: City: State: Injuries: Fatalities: Towed: Date: City: State: Injuries: Fatalities: Towed: 4. Did employee drink an alcoholic beverage while on duty? D YES D NO 5. If employee was NOT subject to DOT drug & alcohol testing requirements, please check here D and skip to question [#7] 6. If employee WAS subject to DOT drug and alcohol testing requirements: YES NO a. Did employee..have an alcohol test result of 0.04 or higher alcohol concentration?... D D b. Did employee..have a verified positive drug test?... D D c. Did employee.. refuse to be tested (including verified adulterated or substituted drug test results)? D D d. Did employee..commit other violations of DOT drug and alcohol testing regulations?... D D..If employee violated a DOT drug and alcohol regulation, please forward copies of the documentation showing their successfully completed DOT return to duty requirements and follow up tests. 7. OPTIONAL: Reason for leaving your employ: D Resigned D Laid Off D Discharged D Other: Excellent Good Fair Poor Very Remarks 8. OPTIONAL: Job Performance: Poor Driving Skill D D D D D Safe & Efficient Driver D D D D D Attitude D D D D D General Conduct D D D D D Name Title Signature Phone Number Date

21 Fax or completed form to: Input Fax # and/or address here

22 Certificate of Compliance Federal Motor Carrier Safety Regulations [Section and 391] states license requirements that each commercial driver must comply with. The requirements are as follows: You may not possess more than one motor vehicle operator s license. 1 You must return additional licenses to the state of issue. 2 If you have more than one license, keep the one from your current state of residence and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed in that state. TO BE COMPLETED BY DRIVER I certify that I have read, understood and will comply with the above requirements. I acknowledge that the following license is the only one I possess: Driver License Number State of Issue Expiration Date Driver's Full Name (Printed) Driver's Signature Date 1 Number of Drivers' Licenses. No person who operates a commercial motor vehicle shall at any time have more than one currently valid commercial motor vehicle operator's license issued only by one State or jurisdiction [FMCSR and ] 1 Driver Application Procedures. Initial commercial drivers license. Prior to obtaining a CDL, an applicant must surrender their non CDL driver's licenses to the State License transfer. An applicant shall apply for a CDL from the new State of domicile within no more than 30 days after establishing his/her new domicile. The applicant shall surrender the CDL from the old State of domicile to the new State of domicile [FMCSR ]

23 Federal Motor Carrier Safety Regulations (FMCSR) Acknowledgement Form I acknowledge receipt of the FEDERAL MOTOR CARRIER SAFETY REGULATIONS (ORS 7A). In addition, I agree to familiarize myself with the Federal Motor Carrier Safety Regulations (FMCSR) of the U.S. Department of Transportation, Parts 40, 380, 382, 383, 387, , 399 subchapter B, Chapter 3, Title 49 of the Code of Federal Regulations, as contained therein. Driver s Printed Name Driver s Signature Date Supervisor Signature

24 Drug and Alcohol Policy for Commercial Drivers Receipt & Acknowledgement I HEREBY ACKNOWLEDGE that I have received, read, and understand my Employer's Controlled Substances and Alcohol Use and Testing Policy and Procedures and that I must abide by the terms as a condition of employment. I understand that during my employment I may be required to submit to a controlled substances and/or alcohol test based on Department of Transportation (DOT) regulations and my Employer's requirements. I also understand that refusal to submit to a controlled substances or alcohol test is a violation of DOT regulations and my Employer's policy, and may result in disciplinary action, including suspension (with or without pay) or termination from this organization. I further understand the consequences related to controlled substances use or alcohol misuse conduct as prohibited by my Employer's policy. I acknowledge that the provisions of my Employer's Controlled Substances and Alcohol Use and Testing Policy and Procedures are part of the terms and conditions of my employment, and that I agree to abide by them. THE UNDERSIGNED STATES THAT HE OR SHE HAS READ THE FOREGOING ACKNOWLEDGEMENT AND UNDERSTANDS THE CONTENTS THEREOF. Printed Name Social Security Number Signature Date

25 Driver s Record of Duty This form must be completed by all commercial drivers prior to driving. First time drivers must report the total time on duty during the immediately preceding 7 days and the time they were last relieved from duty prior to working for the new motor carrier 1. Section 1: Driver Information Driver Name (Print) Driver's License Number State Type CDL Social Security Number XXX XX Class Endorsed Restriction Section 2: All Paid Work Time for All Employers (include both non driving and driving hours) DAY (yesterday) (day before) (day before) (day before) (day before) (day before) (day before) DATE (i.e. 4/26) HOURS WORKED *If Total Hours Worked is zero explain: DUnemployed DRetired DOther: * After 60 on duty hours (non driving and/or driving) in 7 days the driver may NOT drive a commercial vehicle. TOTAL HOURS WORKED* Section 3: Last Date and Time Worked (i.e. May 6, 5:00 pm): A.M. / P.M. Month Day Year Time (Circle One) I hereby certify that the information given above is correct to the best of my knowledge. Driver s Signature Date: Certification of Other Compensated Work First time or intermittent drivers must report all on duty time 2 including time working for other employers. Section 4: Multiple Employer Information (Check One) 1. Are you currently working for another employer? DYes DNo 2. Do you intend to work for another employer while employed with (enter Company name)? DYes DNo I hereby certify that the information above is true. I understand that if I begin working for compensation for any additional employer(s) I must inform (enter Company name) immediately and will report hours worked for the additional employer(s) each time I drive commercially for (enter Company name). Driver s Signature Date: Witness Signature 1 Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations 2 On duty time is defined by the Federal Motor Carrier Safety Regulations Section paragraphs (8) and (9) as: time working in the capacity, employ or service of a motor carrier, or performing any compensated work for any non motor carrier.

26 California Driver Proficiency and Authorized Vehicles Prior to a driver operating a vehicle on a highway unsupervised, the driver must be observed demonstrating their ability to safely operate the motor vehicle they have been hired to operate, including any special equipment [i.e. wheelchair lifts, ramps, tie downs]. Complete this form while or after observing their driving ability. I certify on this day, Date that the driver, has demonstrated to me, at Driver s Name Name Employer Name Title that he/she can safely operate the vehicles/equipment listed below: [check all that apply and complete] D D Vehicle less than 10,000 pounds GVWR Vehicles 10,000 pounds to 26,000 pounds GVWR [i.e. 9 to 21 passenger buses] D Bus with hydraulic brakes passengers D D Automatic transmission only Special equipment (specify) D D D Wheelchair Lift Wheelchair Ramp Wheelchair Tie down Keep a copy in the DQ file 13 CCR 1229 Motor Carriers shall require each driver to demonstrate that the driver is capable of safely operating each different type of vehicle or vehicle combination (i.e., vehicles with different controls, gauges, of different size, or requiring different driving skills) before driving such vehicle(s) on a highway unsupervised. The driver s capability to operate the vehicle shall include special equipment such as wheelchair lifts, ramps, or wheelchair tie downs. This Section shall not apply to a motor carrier who is the owner and sole driver of a vehicle or combination of vehicles. 13 CCR 1234 (b) Driver s Authorized Vehicles. Motor carriers shall maintain a record of the different types of vehicles and vehicle combinations each driver is capable of driving as specified in Section 1229.