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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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Medical Examiner's National Registry Verification - Snap-Out, 2-Ply, Carbonless, 8-1/2" W x 11-3/4" L

Forms are 2-ply, carbonless, 8-1/2" x 11-3/4".

Product Code:27034
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Used by motor carriers to document the required verification that their medical examiners are qualified to conduct drivers' physical exams. 
  • Helps you comply with DOT's 49 CFR §391.23 and §391.51
  • Use each time a commercial vehicle driver undergoes a DOT medical exam
  • Includes fields to enter the following information:
    • Driver's Name and Identification Number
    • Certificate Expiration Date
    • Medical Examiner and National Registry Number
    • Motor Carrier and Location
    • Motor Carrier Representative Signature and Date
  • Snap out format
  • Two plies
  • Carbonless
  • Measures 8-1/2" x 11-3/4"

Carbon Type: Carbonless

Number of Plies: 2

Compliance Topic: Driver Qualification & Hiring, Injury & Illness Recordkeeping

Size: 8.5" x 11.75"

Format: Snap-out

Need to Purchase a Case?: 2,000 per case

Industry: Human Resources, Transportation

UNSPSC Number: Examination booklets or forms - 14111533

Advantage Savings: Advantage Savings

Country Of Origin: USA