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Amputee Waiver Requirements

Amputee waiver applications may have to appear at a waiver board hearing. When the complete packet is received, it will be reviewed. Packets for a limb impairment waiver must include:

  1. MC-027 - Application for Intrastate Medical Waiver.
  2. A Medical Examination Report for Commercial Driver Fitness Determination (Form MCSA-5875) completed by a medical examiner familiar with the requirements of 49 CFR 391.41. (DOT Physical)
  3. Application for employment for company applicant intends to drive for.
  4. A copy of the driver's official driving record.
  5. A copy of crash reports for any accidents applicant was involved in during the previous five years.
  6. An evaluation by the treating physician of onset, treatment, prognosis, use of prosthesis, and doctor's opinion on the driver's ability to safely operate a commercial vehicle.
  7. The employer must evaluate the applicant's ability to safely operate the type of vehicle(s) to be driven if a waiver is approved. A statement indicating the employer's opinion on the applicant's ability to safely operate a commercial motor vehicle and perform the essential job functions is required.