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Limb Impairment Waiver Requirements

Limb impairment 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. A second medical evaluation of the impairment including the physician'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.