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Occupational Health

Your DOT Examination Guide

Heywood Healthcare Occupational Health

For More Information

To learn more about how Heywood Healthcare’s Occupational Health Services can help you and your employees, please call or email us.

Examination Guide

Thank you for scheduling your DOT examination with us! We are happy to provide this servie and look forward to seeing you. Please read the guidance provided below carefully to help eliminate any avoidable delays that may occur if you don’t have the appropriate medical documentation.

If you have any health conditions, please take note of any guidance for specific conditions.

Prior to the day of the Examination: 

  1. Review the Health Conditions checklist for any chronic health conditions you may have. 
  2. This is very important especially if you have diabetes, heart disease, obstructive sleep apnea, a neurological condition or are on any medication that is a controlled substance such as hydrocodone or oxycodone. 
  3. If you are on any medication, either print the list out of your electronic medical record, or complete the CMV Driver Medication Form MCSA-5895 or write it down. The list must be readable and MUST include the name of the medication, the dose and how often you take the medicine.
  4. If you are an insulin dependent diabetic please print the Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870. Please have the Provider caring for you complete the form. Please bring the completed form with you to your exam
  5. If you have been diagnosed with monocular vision. Please print the Vision Evaluation Form MCSA-5871. Please have your Ophthalmologist or Optometrist complete the form. Please bring the completed form with you your exam.
  6. Click here for information related to your upcoming DOT Exam at Occupational Health. 

On the day of the Examination:

  1. Avoid any caffeinated beverages and this includes coffee, most sodas and energy drinks. Caffeinated beverages can increase your blood pressure. 
  2. Take your regularly scheduled medications including blood pressure medications, if any. 
  3. Bring the following items: 
    • Valid driver’s license and/or official photo ID. 
    • List of medications mentioned above with the name of the prescribing provider. 
    • If you have been prescribed glasses/contacts and/or a hearing aid, you must bring them. 
    • If you have a chronic health condition, bring additional documentation that might be required based on the guidance provided by the links above. Bring the following items:  

     4.  Complete section 1 of FMCSA form MCSA-5875. Click this link to download the                  form. 

    • Please complete the form prior to arriving if possible. 
    • You must complete the health history to the best of your knowledge. Please note that you must certify that your responses are complete and true. Making a false statement or concealing a medical condition may invalidate the exam and the certificate issued and may expose you to other penalties. 

    5. Plan to arrive early (15 minutes if you have completed the form or at least 30
        minutes if you have not completed the form,). Don’t be late and don’t rush. Stress
        raises your blood pressure and we want to avoid that as much as possible.

New Patient Information

Your First Appointment
Welcome to Occupational Health. If you are interested in making an appointment with us, please call 978-630-6545.  For your first appointment, please print out and bring the completed forms below with you to your appointment:

  1. Occupational Health Registration Form
  2. Consent to Care and Treatment Form  (Form 96-23365)
  3. OH Financial Policy (Form 96-23416)
  4. Notice of Privacy Practices

Health Conditions

  • Obtain a letter or clinic note from your treating provider that you are being managed for your diabetes, your diabetes is stable and controlled, you haven’t had any episodes of hypoglycemia (low blood glucose) and you do not have any significant complications from diabetes, such as retinopathy. 
  •  Bring a copy of your most recent HgA1c report (should be within the last 6 months).

  • Please have your treating clinician/provider (provider who prescribes your insulin) complete MCSA-5870 form in its entirety. Your provider must sign and date the form. Please note that this form requires you to:
    •  Keep electronic downloaded records of your blood glucose preferably for three months. 
    • Obtain a HbA1c in the last 3 months. 
    •  Have a comprehensive diabetic eye examination, presumably within the last year.
  • You must bring the completed and signed MCSA-5870 with you to the clinic. Based on the findings on the form, you may be approved for anywhere between 1 month to 1 year. Please note approval is not guaranteed and we adhere to all regulations and guidelines related to the DOT examination as well as clinic policies and guidelines.


  • Blood pressure needs to be controlled and less than 140/90. Any blood pressure that is 140/90 or higher (but less than 160/100) will result in a DOT certificate limited to no more than 90 days.
  • If you have a diagnosis of hypertension and have a blood pressure of 160/100 or greater, based on DOT regulations we cannot issue you a DOT certificate. 
  • Bring a list of all your medications (including name, dose and frequency).
  • You should have seen your PCP within the last year and preferably have a letter from your PCP indicating your blood pressure is controlled.

Obstructive Sleep Apnea

  • If you have been tested but tested negative for sleep apnea. 
    • You MUST provide a copy of the medical report and/or a note from the doctor who is a sleep specialist indicating that the sleep study was negative for sleep apnea and no further treatment is required. If you have been tested but tested negative for sleep apnea.  
  • If you have been tested and tested positive for sleep apnea. 
    • You MUST provide a copy of the CPAP machine log that provides the last 3 months of records of your use of the CPAP machine. You must demonstrate use of the CPAP machine for more than 4 hours each night more than 70% of the time for the last three months. 
    • You are strongly encouraged to get a letter from your Sleep Specialist that documents that you have been compliant with the use of the CPAP machine and your sleep apnea is being appropriately treated. 
  • If you have tested positive for sleep apnea but do not think either of the above scenarios apply to you, please contact our clinic and provide us the details. We will be glad to review your situation and advise what you will need in terms of medical documentation. A lack of proper documentation for sleep apnea is a frequent reason for a delay in the examination approval process or sometimes an outright failure of the examination.

Coronary Heart Disease (history of heart attack)

  • If you have had a recent heart attack in the last three months. 
    • There are significant rules about what evaluation and documentation is required. Please contact the clinic and let us know your details and we can help you. 
  •  If you have a history of a heart attack in the past and/or had a stent placed. 
    • Annual evaluation by a cardiologist who should prepare a letter indicating you are stable and can drive a DOT regulated vehicle. 
    • Stress test every two years. 
    • If the stent was placed in the last 6 months, a recent stress test is required.  
  • If you have a history of a heart bypass operation (CABG). You must be more than 3 months past your bypass surgery. 
    • Evaluation by a cardiologist who should provide a letter or clinic note documenting that you are safe to drive a DOT regulated vehicle. 
    • Heart echocardiogram or alternative heart test demonstrating a left ventricular ejection fraction greater or equal to 40%. 
    • Tolerance to the medications. 
    •  Annual exercise stress test if more than 5 years after the heart bypass surgery.

Taking Controlled Substances
Taking Opioid Medication or any Controlled Substance (examples: Hydrocodone, Oxycodone and Adderall)

  • Please follow up with the provider (doctor or advanced practice clinician) who prescribed the opioid medication or controlled substance medication and obtain a letter confirming that you are on the medication listed and that you are “safe to drive/operate a Commercial Motor Vehicle”. Please note that having the letter does NOT guarantee that you will pass the examination. We have to make a final determination based on the clinical examination and review of your medication and health conditions.
  • In general use of opioid medication and other sedatives is strongly discouraged.