CDME Module 2: Vision and Hearing (2025)-Vision Evaluation Form 5871

Vision Evaluation Form 5871

Pdf Summary

The document provided is a U.S. Department of Transportation Federal Motor Carrier Safety Administration form, labeled as MCSA-5871, with an OMB Control Number of 2126-0006, which is valid until March 31, 2025. This form is a Vision Evaluation Report, used to assess whether individuals meet the vision standards required to operate a commercial motor vehicle in interstate commerce.<br /><br />The form primarily targets individuals with "monocular vision" or those who did not meet the FMCSA’s vision standard during a physical qualification examination. An ophthalmologist or optometrist fills out this report, and their evaluation is part of the process that determines whether an individual meets FMCSA's requirements. Key requirements for meeting these vision standards include having at least 20/40 distant visual acuity in the better eye, a field of vision of at least 70 degrees horizontally, and the ability to recognize standard traffic signal colors.<br /><br />The document includes fields for identifying details like name, driver’s license number, and date of birth, as well as vision evaluation details such as the date of evaluation, test used, treatment details, and the presence of any progressive eye conditions. The eye care professionals completing the form must detail current treatments, the stability of conditions, and provide information on comprehensive eye examinations. The form supports the FMCSA's safety goals, ensuring drivers maintaining sufficient visual acuity and field of vision for safe vehicle operation.<br /><br />It is of utmost importance that this document is handled securely, given its sensitive nature, and it should only be accessed and disposed of by authorized personnel following regulatory requirements to protect the individuals concerned.

Keywords

MCSA-5871

Vision Evaluation Report

monocular vision

FMCSA

ophthalmologist

optometrist

visual acuity

interstate commerce

field of vision

safety standards