DOT vision and hearing requirements

To pass the vision part of a DOT physical you need at least 20/40 in each eye and 20/40 with both eyes, with or without glasses or contacts, at least 70 degrees of horizontal field in each eye, and the ability to recognize red, green and amber signals (49 CFR 391.41(b)(10)). For hearing you must perceive a forced whisper at 5 feet or more in your better ear, or have an average loss of no more than 40 decibels in the better ear at 500, 1,000 and 2,000 Hz, with or without a hearing aid (391.41(b)(11)). Drivers who cannot meet the vision standard in one eye now have a regulatory route in 391.44, and deaf or hard of hearing drivers can apply for an FMCSA hearing exemption.

The vision standard

391.41(b)(10)(i) has four parts, and all four must be met:

A person who fails the worse-eye acuity standard with correction, or the field standard, or both, can qualify under 391.44 instead (391.41(b)(10)(ii)). There is no alternative route for color.

How vision is tested and recorded

The MCSA-5875 records acuity for the right eye, left eye and both eyes, uncorrected and corrected; horizontal field in degrees for each eye; whether you can recognize and distinguish red, green and amber; whether you have monocular vision; and whether you were referred to, and brought documentation from, an ophthalmologist or optometrist. The form instructions tell the examiner to give results in Snellen-comparable values when another chart is used, and to use 20 feet as normal for distance.

• Who can test. The examiner on the National Registry, or, for the vision part only, a licensed ophthalmologist or optometrist (391.43(b)(1)).
• Glasses and contacts. Bring whatever you drive in. FMCSA's 2024 Handbook notice (89 FR 3892) says that if you meet the standard with corrective lenses, it is not necessary to document uncorrected acuity. The certificate then carries the "wearing corrective lenses" box, recording that you met the standard with them.
• The field test. The standard is horizontal field in each eye, measured separately. It is often called the peripheral vision test.

One eye, or one weak eye: the alternative vision standard

Since 22 March 2022 (87 FR 3390), a driver who does not meet, with the worse eye, the corrected acuity standard or the field standard, or both, can be qualified under 391.44. The rule replaced FMCSA's vision exemption programme. The steps:

1. Eye specialist first. Before the exam, you are evaluated by a licensed ophthalmologist or optometrist, who completes and signs the Vision Evaluation Report, MCSA-5871 (391.44(b)).
2. Examiner within 45 days. The medical exam must begin no more than 45 days after the eye specialist signs and dates the MCSA-5871, and must happen at least annually (391.44(c)). The examiner keeps the report with the MCSA-5875 (391.44(c)(1)).
3. The examiner decides, using independent medical judgement and these standards from 391.44(c)(2). You are not qualified if:
   • in the better eye, distant acuity is not at least 20/40 with or without correction and the field is not at least 70 degrees horizontally;
   • you cannot recognize standard red, green and amber;
   • your vision deficiency is not stable; or
   • not enough time has passed since it became stable for you to adapt to and compensate for the change.
4. Road test the first time. A driver qualified under 391.44 for the first time must not drive until completing a road test with the motor carrier under 391.31 and must tell the carrier a road test is required (391.44(d)(1)). The equivalent-of-road-test option in 391.33 does not apply. Exceptions in 391.44(d)(3) to (5) cover drivers who operated a commercial vehicle with the deficiency for the 3 years before, in intrastate or excepted interstate commerce, with a valid license, and drivers who held a federal vision exemption or were certified under the old vision waiver study programme on 22 March 2022.

Drivers certified under 391.44 are on a 12-month maximum (391.45(f)). The Handbook notice adds that the alternative standard applies only if the worse eye cannot be corrected to meet the acuity standard with lenses.

The carrier's side of the 391.44 road test

The road test in 391.44(d) is a carrier duty as much as a driver one. The carrier conducts it under 391.31(b) to (g) and issues the certificate of road test. Where the carrier decides the 3-year experience exception in 391.44(d)(3) applies, the driver must certify in writing the date the vision deficiency began, and the carrier must:

• prepare a written statement that it determined the driver held a valid license and operated a commercial vehicle with the deficiency for the 3 years immediately before first qualifying under 391.44, so no road test is required;
• give the driver a copy; and
• keep the original statement, and the driver's certification of the date the deficiency began, in the driver qualification file (391.44(d)(3)(ii)).

Drivers who held a federal vision exemption on 22 March 2022, or were certified under the old waiver study programme on that date, are excepted from the road test and are not required to tell the carrier that they are excepted (391.44(d)(4) and (5)). Every other driver qualifying under 391.44 for the first time must tell the carrier responsible for the road test that one is required, and cannot use the equivalent-of-road-test option in 391.33 for it (391.44(d)(2)).

What to bring for the vision and hearing tests

• The glasses or contacts you drive in, and any hearing aid you use, with fresh batteries.
• If you are under the alternative vision standard, the signed MCSA-5871, dated within the last 45 days.
• If you hold a hearing exemption, a copy of it.
• If you have had eye surgery or a recent change in vision, the eye specialist's records, because 391.44(c)(2) asks whether the deficiency is stable and whether you have had time to adapt.

The hearing standard

391.41(b)(11) offers two ways to pass, and the better ear is what counts:

• Forced whisper: you first perceive a forced whispered voice in the better ear at not less than 5 feet, with or without a hearing aid; or
• Audiometry: you do not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz and 2,000 Hz, with or without a hearing aid, with the audiometer calibrated to ANSI Z24.5-1951.

How the hearing test is done

Paragraph I of the Medical Advisory Criteria (Appendix A to Part 391) describes it:

• Whisper test (I.2). You stand at least 5 feet from the examiner with the tested ear turned toward them and the other ear covered. Using the breath left after a normal breath out, the examiner whispers words or random numbers such as 66, 18, 3, and asks you to repeat them, without using only "s" sounds. The other ear is tested the same way. If you fail in both ears, the audiometric test should be given.
• Audiometry (I.1). Because the rule uses the ANSI standard, results from an ISO-calibrated audiometer may need converting: subtract 14 dB at 500 Hz, 10 dB at 1,000 Hz and 8.5 dB at 2,000 Hz, then add the three and divide by 3 for the average.

Worked example: converting an audiogram

Invented figures, to show the arithmetic in paragraph I.1. A driver's better ear measures 55, 50 and 45 dB on an ISO-calibrated audiometer at 500, 1,000 and 2,000 Hz. Converted to ANSI: 55 minus 14 is 41; 50 minus 10 is 40; 45 minus 8.5 is 36.5. The sum is 117.5, and 117.5 divided by 3 is about 39.2 dB. That average is not greater than 40, so the driver meets the audiometric standard in that ear. Without the conversion the ISO average would be 50 dB, which would not.

Hearing aids

The standard can be met with a hearing aid, and the form records whether one was used and in which ear. The certificate then carries "wearing hearing aid", recording that you met the standard with it. Paragraph I.3 of the criteria adds a point of form: if a driver does not meet the standard even with a hearing aid and needs a federal hearing exemption, the "wearing hearing aid" box should not be ticked on either the MCSA-5875 or the MCSA-5876; only the box for "accompanied by a hearing exemption" is.

Deaf and hard of hearing drivers: the FMCSA hearing exemption

Drivers who cannot meet 391.41(b)(11) can apply to FMCSA for an exemption. Paragraph I.4 of the criteria gives FMCSA's contact route: phone (202) 366-4001 or the hearing applicant page on FMCSA's website. FMCSA publishes each group of decisions in the Federal Register. From its September 2026 renewal notice (91 FR 60696):

• FMCSA grants medical exemptions for 2 years, to match the maximum medical certification period, and they may be renewed.
• The standard is whether granting the exemption is likely to achieve a level of safety equivalent to or greater than without it (49 U.S.C. 31315(b)(1)). FMCSA reviews the driver's certified state driving record and any crash reports.
• Conditions: report any crash to FMCSA within 7 days; report citations and convictions for disqualifying offences under Parts 383 and 391 within 7 days; submit an annual certified driving record from the state; do not operate a motorcoach or bus with passengers in interstate commerce; carry a copy of the exemption when driving; and meet all applicable CDL testing requirements.
• The exemption can be revoked if the driver fails to comply with its terms or if safety falls below the level before it was granted.

Carrying the exemption is also required by 391.41(a)(1)(ii), which applies to anyone qualified by virtue of a medical variance.

Common mistakes

• Forgetting the glasses you drive in. The standard is met with correction, and the certificate says so.
• Assuming color blindness can be waived. 391.41(b)(10)(i) and 391.44(c)(2)(ii) both require recognizing red, green and amber.
• Letting the MCSA-5871 go stale. The exam must begin within 45 days of the eye specialist signing it.
• Driving before the road test after a first 391.44 certification, unless an exception in 391.44(d) applies.
• Looking for the old vision waiver. It was replaced by 391.44 in 2022.
• Leaving the hearing exemption at home. It must be in the cab.

Your state may apply different vision or hearing rules to drivers who operate only within the state. This page covers the federal interstate standard. The full list of physical standards is on the DOT physical requirements page, and the visit itself is described on what happens at a DOT physical.

Certified examiners near you are listed in the DOT physical directory.