Driver Compliance: Substance Abuse and Alcohol Misuse Report
This file is a compliance report form used by drivers and employers to ensure adherence to the Federal Motor Carrier Safety Administration (FMCSA) regulations. It includes guidelines for the use of prescription medications and how they affect the ability to operate commercial motor vehicles safely. The form must be filled out by the prescribing physician and returned to the employer.
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How do I fill this out?
To fill out this form, the driver should provide it to their prescribing physician. The physician will then complete the required sections, indicating whether the prescribed medications will affect the driver's ability to drive safely. Finally, the completed form should be returned to the employer.
How to fill out the Driver Compliance: Substance Abuse and Alcohol Misuse Report?
1
Provide the form to the prescribing physician.
2
The physician completes their personal and the driver's information.
3
List the medications prescribed and indicate if they affect the ability to drive safely.
4
Physician signs and dates the form.
5
Return the completed form to the employer.
Who needs the Driver Compliance: Substance Abuse and Alcohol Misuse Report?
1
Full-time drivers who are taking prescription medications.
2
Part-time drivers who need to ensure compliance with FMCSA regulations.
3
Employers who must verify their drivers can safely operate commercial vehicles.
4
Substitute drivers who are on medication.
5
Contractor-supplied drivers who need medical clearance to drive.
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What are the instructions for submitting this form?
To submit this form, complete all required sections and ensure it has been signed by the prescribing physician. Then, return the form to your employer using one of the following methods: Email the completed form to HR@example.com. Fax the form to (555) 123-4567. Use the online submission form on the company’s intranet site. Mail the form to: EH&S DOT Program, 4600 Health Sciences Road, Irvine, CA 92614. Ensure that the form is submitted promptly to avoid any delays in compliance.
What are the important dates for this form in 2024 and 2025?
This form should be submitted as soon as the driver begins taking the prescribed medications. It must be resubmitted if there are any changes in medication or dosage in 2024 and 2025.
What is the purpose of this form?
The purpose of this compliance report form is to ensure that commercial motor vehicle drivers who are taking prescription medications adhere to the Federal Motor Carrier Safety Administration (FMCSA) regulations. Specifically, it addresses the requirements outlined in Title 49 CFR Part 382.213 regarding the use of controlled substances and their potential impact on driving abilities. By completing this form, drivers and their prescribing physicians can provide necessary information to ensure that the driver can safely operate a commercial vehicle. This ensures both the safety of the driver and the public while maintaining compliance with federal regulations.
Tell me about this form and its components and fields line-by-line.
- 1. Physician's Name: The full name of the prescribing physician who is treating the driver.
- 2. Driver's Name: The full name of the driver for whom the physician is prescribing medication.
- 3. Medications: List of all prescribed medications the driver is taking.
- 4. Adverse Effects: Indicate whether the medications may adversely affect the driver's ability to safely operate a commercial motor vehicle.
- 5. Physician's Signature: Signature of the prescribing physician confirming the information provided is accurate.
- 6. Physician's Address: The address of the prescribing physician's practice.
- 7. Date: The date on which the form is signed by the physician.
- 8. Phone: Contact number for the prescribing physician.
- 9. Other Comments: Any additional information the physician considers relevant regarding the driver’s ability to safely operate a commercial vehicle.
- 10. Employer: Name of the employer requesting the form.
- 11. Employer Address: Address of the employer requesting the form.
What happens if I fail to submit this form?
Failure to submit this form can lead to serious repercussions for both the driver and the employer. It is essential to adhere to DOT regulations to maintain safety and compliance.
- Non-Compliance: Failing to submit the form results in non-compliance with FMCSA regulations, which can lead to penalties.
- Safety Risks: Without the form, there is an increased risk of impaired driving, which can result in accidents and injuries.
- Employment Consequences: The driver may be temporarily removed from safety-sensitive duties, affecting their employment status and income.
How do I know when to use this form?
- 1. Starting New Medication: When a driver is prescribed new medication that could affect driving.
- 2. Medication Changes: If there are changes to the dosage or type of medication a driver is taking.
- 3. Regular Medical Review: During regular medical check-ups to ensure ongoing compliance with safety regulations.
- 4. Employer Request: When an employer requests confirmation of a driver's ability to drive safely while on medication.
- 5. DOT Audit: In case of a DOT audit to provide documentation of compliance with substance use regulations.
Frequently Asked Questions
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How do I fill out the prescription information?
The prescribing physician should list all prescribed medications and indicate if they affect the ability to drive safely.
Can I sign the PDF form digitally?
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Who needs to complete this form?
This form must be completed by the driver’s prescribing physician and returned to the employer.
What information does the employer need to provide?
The employer should fill out the bottom left section with the Employer/Address information before giving the form to the driver.
Can this form be used for non-prescription medications?
No, this form is specifically for prescription medications. Over-the-counter medication guidelines require different procedures.
What happens if the medications affect my ability to drive?
The physician will indicate on the form if the medications affect the driver’s ability to drive, and the employer should remove the driver from safety-sensitive duties temporarily.
Is this form required for DOT compliance?
Yes, this form ensures compliance with the Department of Transportation's regulations regarding substance use and safety-sensitive functions.
