JJ KELLER part description

Alert: Regulation Change to the Medical Examination Report Form, MCSA–5875 - Effective September 7, 2021
The updated form includes an OMB expiration date of 11/30/2021. As a result, we expect additional form changes from the OMB in the future.


  • Allows you to keep Alcohol & Drug Forms, Safety Performance History Forms and Driver Qualification Forms secure and in one convenient location
  • Each file packet includes a 9-1/2" W x 11-3/4" file folder and the following forms:

Driver Qualification

Alcohol and Drug

Safety Performance History

*Not sold separately


Interested in a license to use these forms electronically?
For a quote to use these forms electronically, such as on your company intranet, or with form-fillable fields, contact us at customsolutions@jjkeller.com or 1-800-327-6868 to discuss. Learn more.

JJ Keller® is an industry expert in safety and compliance. It provides organizations of all sizes with the right tools and expert advice to create productive, safe, and compliant workplaces. While it does offer managed and consulting services regarding safety and compliance for DOT regulations, it also supplies a wide range of training materials and tools and a comprehensive list of digital and printed publications, forms, and supplies. DOT compliance for fleets has never been easy with JJ Keller. Its wide assortment of decals, placards, and flags helps keep employees and drivers safe and in compliance while on the job.

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