Driver Qualification File Checklist
(CSA2010 Driver Fitness)

Employee Name: _________________________________

1. ___ Driver Application for Employment (391.21). 
Date: ________________

2. ___ Medical Examiners Certificate (391.41, 391.43). 
Exp. Date: _____________
 
3. ___ Record of Road Test or Equivalent & Certification of Road Test or Equivalent (391.31 (e)391.33).
  

4. ___ Copy of Valid State Driver’s License (391.31 (e) (391.33).
DL #___________
State: _______________
Class: _______________
Exp. Date: _____________
CDL – Endorsements (383): _____________________

5. ___Pre-Employment Request for Check of Driving Record (MVR).(391.23 (a) (1) 391.25 (e)) Driver needs to complete a separate form for each state he  has held a DL from for preceding 3 years. Include responses from each state.

6. ___ Certification of Compliance with Driver’s License Requirements (383-391)

7. ___ Drivers Statement of On-Duty Hours (395.8 (j) (2))
 
8. ___ Former Employee Verification Form – Safety Performance History. Record Request and Drug and Alcohol History for preceding 3 years (391.23, 382.413, 40.25). Driver to complete a separate form for each employer for preceding 3 years. Include responses from each previous employer.

9. ___ Previous Pre-Employment Employee Alcohol & Drug Test Statement (40.25 (j)) Include responses from each previous employer. 
  
10. ___ Receipt for copy of Company Drug and Alcohol Policy (382) 
  
12. ___ Copy of Waiver Letter if applicable (391.49)

13. ___ Annual review of driving record & record of violations (391.25 – 391.27)


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