For commercial driver fitness determination form

 · It is the responsibility of the applicant to provide that evidence to TREC. [Rule (d)] Before applying for a license, a person may request TREC to determine whether the person’s fitness complies with the requirements for licensing by filing a Fitness Determination (FT). This form is on our website here. FOR COMMERCIAL DRIVER FITNESS DETERMINATION F () 1. DRIVER'S INFORMATION Driver completes this section Date of Exam M Recertification M / D / Y Driver's Name (Last, First, Middle) Social Security No. Birthdate Age Sex New Certification F Follow-up Address City, State, Zip Code Work Tel: () Driver License No. License Class State of Issue A C Home Tel: () B D Other 2. FOR COMMERCIAL DRIVER FITNESS DETERMINATION 2. HEALTH HISTORY Driver completes this section, but medical examiner is encouraged to discuss with driver. Yes No Any illness or injury in last 5 years? Lung disease, emphysema, asthma, chronic bronchitis Head/Brain injuries, disorders or illnesses Kidney disease, dialysis.

FOR COMMERCIAL DRIVER FITNESS DETERMINATION 2. HEALTH HISTORY Driver completes this section, but medical examiner is encouraged to discuss with driver. Yes No Any illness or injury in last 5 years? Lung disease, emphysema, asthma, chronic bronchitis Head/Brain injuries, disorders or illnesses Kidney disease, dialysis. FOR COMMERCIAL DRIVER FITNESS DETERMINATION 1. 2. Driver’s Name (Last, First, Middle) Social Security No. Birthdate Age Sex Date of Exam Address City, State, Zip Code Work Tel: () Driver License No. License Class State of Home Tel: () Issue Driver completes this section. for commercial driver fitness determination 1. driver information driver completes this section. print in capital letters - using black or dark blue ink. last name first driver license number address city state zip , 5-1)0/ /6.#3 ())0. 5-1)0/ /6.#3 () social security number license class a cb state of issue.

Application for School Bus Driver Enrollment Certificate, SBTdoc Medical Examination Report for Commercial Driver Fitness Determination, SBTpdf. The principal assessment tool we use for this is the Driver's Medical Examination Report. Examination reports help determine if a driver's medical condition. Commercial drivers are required to certify using PennDOT's Self-Certification Form (DLCD)(PDF). This webpage contains information and instructions to.