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391.41(b)(1) Amputee & 391.41(b)(2) Limb Impairment

An amputee or person with a limb impairment who is otherwise qualified under 49 CFR 391.41 may be granted an intrastate waiver (aka skill performance evaluation) exempting the driver from the requirements of 391.41(b)(1) or 391.41(b)(2) as applicable if all supporting documentation is favorable and there is nothing to indicate the driver would not be able to safely operate a vehicle without compromising safety. Michigan does not conduct a Skill Performance Evaluation (SPE) for intrastate drivers and defers that responsibility to the employing motor carrier to conduct an evaluation of the driver's ability and submit a statement along with the application. At least one of the medical exams submitted should indicate whether any adaptive devices or vehicle modifications are necessary.

Forms and documentation required for this waiver are listed below. MC forms are available for download by clicking on the form name. The MCSA forms are available from your DOT examiner.

MC-027 Application for Medical Waiver (Completed by both driver and carrier)

MC-028 Physician's Statement, only sections E and F (Completed by driver's treating physician)

MCSA-5875 Medical Examination Report Form (Completed by DOT Examiner)

MCSA-5876 Medical Examiner's Certificate (Completed by DOT Examiner)

Driver's application for employment (initial or new carrier applications only)

Copy of driver's official driving record (From Michigan Secretary of State)

Copy of any crash report regardless of fault for previous five years

Skill Performance Evaluation - Statement of carrier's evaluation

Pictures of adaptive devices if required by either examination or deemed necessary


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