Form MCSA-5871. Vision Evaluation Report
The Vision Evaluation Report, Form MCSA-5871, is a crucial document used by the Federal Motor Carrier Safety Administration (FMCSA) for commercial motor vehicle (CMV) drivers who are required to undergo a vision examination. This form serves as a crucial record of the driver's visual capabilities and helps ensure public safety on the roadways.
Form MCSA-5871 consists of several key sections, which include:
- Driver Information: In this section, the CMV driver provides personal details such as name, date of birth, license number, contact information, and mailing address.
- Visual Acuity Measurements: This section includes measurements of the driver's distant visual acuity (uncorrected and corrected) for both eyes and each eye individually.
- Visual Fields: In this section, details about the driver's horizontal visual fields are provided.
- Eye Condition and Treatment History: This section requires the driver to disclose any existing eye conditions or history of treatment, such as surgery or medication use.
- Eye Care Professional's Certification: The examining eye care professional (optometrist or ophthalmologist) must provide their information, sign, and date the form, verifying the accuracy of the examination.
The most important fields in the Vision Evaluation Report include the visual acuity measurements, visual fields, and the certification by the examining professional.
Form MCSA-5871 is typically required for CMV drivers who have any known visual impairment or when there is a need for detailed evaluation of their visual capabilities. The parties involved in the document include the CMV driver and the examining eye care professional.
When compiling the form, it is crucial to provide accurate and complete information to avoid any delay in the processing of the driver's medical certification. Additionally, the form must be completed truthfully to ensure public safety on the roads.
The advantages of this form include maintaining a standardized process for evaluating a driver's visual capabilities, reducing the risks associated with visually impaired drivers operating commercial vehicles, and facilitating public safety.
Some potential problems that may arise when filling out the form include incomplete information, errors in the details provided, or an unqualified professional conducting the examination.
Related forms include the Medical Examination Report (MER) Form, MCSA-5875, and the Medical Examiner's Certificate (MEC), Form MCSA-5876.
Form MCSA-5871 should be submitted to the medical examiner responsible for the driver's medical certification. The medical examiner will use the information to determine the driver's qualification to operate a CMV. The form's instances are typically stored by the medical examiner as part of the driver's medical records.