A physical exam varies depending on the job and the time on the job. The purpose of a physical is to protect the worker from overexertion or strain, to protect the company from liability for unknown physical limitations for that worker, and to set baselines for health to be re-evaluated in the future.
Here, we’ll focus on DOT certification physicals. While a new hire physical tests for basic physical ability, the following physical is more in-depth as there is more risk to the employee and to the population at large if performed poorly.
DOT certification physicals
The DOT certification exam is standard and should be similar regardless of the provider. As part of the DOT physical exam, drug and alcohol testing, as well as Clearinghouse registration and/or validation are often required.
Components of the DOT physical examination include:
- General appearance: The medical examiner makes note of a variety of factors, including obesity, abnormalities with posture, limps, tremors, or other conditions that might indicate an illness or other concern.
- Head and eyes: Eye charts are used to assess visual acuity (sharpness/clarity of vision from a distance) so a driver who normally wears corrective lenses may wear them during the exam. Contact lens wearers must be well adapted to them.
- Ears: The medical examiner notes any evidence of ear disease, such as Meniere’s disease or vertigo. Two tests of hearing may be used. Failing the first – a forced whisper test – means the medical examiner may administer an audiometric test. (An examiner may reverse the order of the two tests, but the driver must pass one to be certified.)
- Throat: The medical examiner looks for any deformities likely to interfere with breathing or swallowing.
- Heart: The medical examiner inspects for any current irregularities in heart function or evidence of an enlarged heart, congestive heart failure, or other cardiovascular disease. If the medical examiner determines an electrocardiogram is indicated, one may be performed.
- Blood pressure (BP): If a driver has hypertension and/or is being medicated for hypertension, recertification should occur more frequently than the standard once every 24 months.
- A driver diagnosed with Stage 1 hypertension (BP is 140/90-159/99) may be certified for one year. At recertification, an individual with a BP equal to or less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time certificate for three months may be issued.
- A driver diagnosed with Stage 2 hypertension (BP is 160/100-179/109) should be treated and a three-month certification may be issued.
- A driver with Stage 3 hypertension (BP is higher than 180 systolic and/or 120 diastolic pressure) requires immediate medical attention and cannot be certified.
- Lungs: The medical examiner looks for any abnormality in chest wall expansion, respiratory rate, and breath sounds. In addition, they look for impaired respiratory function, shortness of breath or cyanosis (which is when the skin has a bluish cast due to poor circulation or oxygen supply). The medical examiner may require pulmonary function tests and/or chest X-rays, if indicated.
- Abdomen and viscera (internal organs in the main body cavity: The medical examiner will inspect for any weakness or tenderness in the abdominal wall, enlargement of the liver or spleen, and the presence of masses. Further testing and evaluation may be required if any abnormalities are found that might interfere with the safe operation of a commercial motor vehicle.
- Genitourinary examination: A urinalysis is required for assessment of protein, blood, and sugar levels. Elevated levels may indicate an underlying medical problem. The medical examiner is also required to check for hernias.
- Neuro exam: The medical examiner assesses the function of the brain and nervous system, with a focus on mental awareness, motor function and balance, sensory response, and reflexes. Impairment of equilibrium or abnormal neurological responses may require further testing to rule out a disqualifying condition. Any neurological condition is evaluated on the general nature and severity of the condition, the degree of limitation it presents, and the likelihood of progression to more limited function or sudden incapacitation.
- Spine and musculoskeletal exam: The medical examiner will assess the result of previous surgery and examine for any deformities, limitation of motion, and tenderness in muscles, bones, and joints before deciding whether additional testing/evaluation is needed.
- Extremities: This part of the exam notes any loss or impairment in function of legs, feet, toes, arms, hands, or fingers, as well as any deformities, atrophy, or paralysis that would interfere with operating a commercial motor vehicle.
- Laboratory and other testing: Based on the medical history and findings of the physical examination, the medical examiner may order additional lab work or tests.