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How do I fill this out?
To fill out this form, begin by providing the driver's personal details, including their full name and address. Next, indicate the applicable Federal Motor Carrier Safety Regulations being followed. Finally, ensure that a licensed medical examiner signs and dates the certificate for it to be valid.

How to fill out the Form MCSA-5876 Medical Examiner's Certificate?
1
Provide the driver's basic information, including full name and address.
2
Select the applicable Federal Motor Carrier Safety Regulations.
3
Indicate any applicable waivers or exemptions.
4
Obtain a signature from the medical examiner.
5
Submit the completed form as directed.
Who needs the Form MCSA-5876 Medical Examiner's Certificate?
1
Commercial drivers need this form to legally drive a commercial vehicle.
2
Employers of commercial drivers require it for compliance with federal regulations.
3
Medical examiners utilize it to record driver health assessments.
4
State authorities may need it for driver licensing purposes.
5
Insurance companies may request it to assess risk before coverage.
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What are the instructions for submitting this form?
To submit the MCSA-5876 form, mail it to the Federal Motor Carrier Safety Administration at MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590. Alternatively, fax the completed form to (202) 366-3477. Be sure to keep copies for your records and ensure submission prior to any deadlines.
What are the important dates for this form in 2024 and 2025?
The MCSA-5876 form expiry is on 11/30/2021. Ensure to check for any updates regarding the form in 2024 and 2025. Compliance with these dates is crucial for valid documentation.

What is the purpose of this form?
The MCSA-5876 form serves to certify that commercial drivers meet the required medical standards. It provides essential documentation for ensuring the safety of drivers on the road. This certification is necessary for compliance with federal and state regulations governing commercial vehicle operation.

Tell me about this form and its components and fields line-by-line.

- 1. Last Name: Driver's last name.
- 2. First Name: Driver's first name.
- 3. Driver's Address: Residential address of the driver.
- 4. Medical Examiner's Signature: Signature of the medical examiner certifying the driver.
- 5. Medical Examiner's Telephone Number: Contact number of the medical examiner.
What happens if I fail to submit this form?
Failure to submit the MCSA-5876 form may lead to penalties, including legal ramifications for non-compliance. It is crucial for commercial drivers to ensure timely submission to avoid disruptions in their ability to operate legally. Always consult with your employer for guidance on submission timelines.
- Legal Penalties: Non-submission could result in fines or legal action.
- Loss of Driving Privileges: Drivers may not be permitted to operate until form is submitted.
- Job Impact: Failure to submit may affect job status or employment.
How do I know when to use this form?

- 1. Annual Medical Exams: To certify health standards for continued driving.
- 2. New Employment: Required by employers for new commercial driver hires.
- 3. License Renewals: Needed for renewing commercial driving licenses.
Frequently Asked Questions
What is the MCSA-5876 form?
The MCSA-5876 is a medical examiner's certificate form required for commercial drivers in the U.S.
How can I edit the MCSA-5876 form?
Editing can be done directly on PrintFriendly by opening the PDF and using the available tools.
Is signing the MCSA-5876 form secure?
Yes, signing on PrintFriendly ensures your document remains secure and official.
Can I share my edited form?
Absolutely! You can share your modified MCSA-5876 PDF via email or link.
What does the form include?
The form includes personal details of the driver, medical examiner information, and regulatory compliance checks.
Do I need to print the form?
You may print the form after editing if necessary for physical submission.
Can I save my edits?
Yes, you can download your edited document directly to your device.
Who fills out the MCSA-5876 form?
A licensed medical examiner completes this form based on the driver's health assessment.
Why is the MCSA-5876 important?
It ensures that commercial drivers meet health standards to operate safely.
Where can I submit the MCSA-5876 form?
Submit the completed form to your employer or the relevant state authority.
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