psats rogram river ualification iles program - new hire forms...driver safety records, prospective...

PSATS CDL PROGRAM

CMV/CDL DRIVER QUALIFICATION FILES (DQF)

PSATS CDL Program ▐ 4855 Woodland Drive ▐ Enola, PA ▐ 17025 ▐ (P) 717-763-0930 ▐ (F) 717-763-9732▐ (E) [email protected]

Pennsylvania’s intrastate commercial motor vehicle regulations (67 Pa. Code Chapter

231) now provide even more flexibility for local governments in hiring the employees necessary

for effective road maintenance operations. In accordance with 67 Pa. Code Chapter 231.8(6),

state and local governments and their regularly employed drivers who operate commercial motor

vehicles (CMV) in intrastate travel (within Pennsylvania) are exempt from needing to maintain

records regarding the driving qualifications of those employees. All other employers are still

required to maintain these records for their CMV employees.

However, the pre-employment drug test is still a requirement of all employers when

hiring an employee who will be operating CDL vehicles (any CMV weighing more than 26,001

pounds). Further, employees operating CDL vehicles must also posses a valid commercial

drivers license and be covered by the employer’s random drug and alcohol testing program

Pennsylvania regulations at 67 Pa. Code Chapter 231.8 define a CMV as any motor

vehicle or combination used on a highway in intrastate commerce to transport passengers or

property when the vehicle meets one of the following conditions:

(i) Has a gross vehicle weight rating or gross combination weight rating (GVWR), or

gross vehicle weight or gross combination weight, of 17,001 pounds or more,

whichever is greater.

(ii) Is designed or used to transport more than 8 passengers (including the driver) for

compensation.

(iii) Is designed or used to transport more than 15 passengers, including the driver, and

is not used to transport passengers for compensation.

(iv) Is a school bus.

(v) Is transporting hazardous materials which is required to be placarded in

accordance with Department regulations.

For the many municipalities that still require the maintenance of these records as a

condition of employment, provided below is a discussion of the forms that should be maintained

in each CMV employee’s “driver qualification file” (DQF), which should be kept current, and

stored in a secure location with controlled access.

1. Driver’s qualification file (DQF). Chart CDL FORM HIRING DQF represents the full array

of information and records that should be obtained at time of hire and kept in each CMV

driver’s qualification file (DQF) for the duration of this employee’s employment plus three

years. This form also lists the additional information needed to hire an employee who will be

operating CDL vehicles.

Chart CDL FORM DQF represents the full array of information and records needed each

additional year of this employee’s employment. This information must also be kept in the

employee’s DQF and retained in accordance with the enclosed GUIDANCE - RECORD

RETENTION SCHEDULE.

PSATS CDL PROGRAM

CMV/CDL DQF CONTINUED…

2. Written application for employment. All applicants for CMV employment should provide

a written application for employment using CDL FORM APPLY.

3. Pre-CDL employment drug test result. An applicant for employment that will require the

use of a CDL vehicle must obtain a negative result on a pre-CDL employment drug test prior

to performing CDL duties.

4. Requests for information. The new employer should maintain a written, confidential record

of the following information, or, if no records exist, of the good faith efforts you made to

obtain the information, such as a copy of your request for information. Failure by a past non-

municipal employer to respond to any authorized request for required information must be

reported by the new employer to the FMCSA in accordance with the enclosed GUIDANCE –

FMSCA COMPLAINT. Since Pa. municipalities are exempt from needing to maintain these

driver safety records, prospective employers should be informed if this is the reason that no

response was provided by a municipal employer. In all cases, the employee must sign a

release authorization section of each form sent to previous employers. Refusal to sign any

authorization would prevent the employee from being employed.

a. Review the results of the inquiries to state driver licensing agencies. Employers of

new CMV employees should obtain, within 30 days of such employment, information

about the new employee’s driving record for the past three years from every state in

which the new employee held a valid driver’s license and determine if that employee is

qualified to operate commercial motor vehicles. Employees should sign CDL Form

FCRA Disclosure thereby allowing the employer to electronically obtain the employee’s

drivers license information for the duration of such employment.

Employers must use PENNDOT FORM DL-503 to obtain information by mail for

Pennsylvania license holders and CDL FORM OTHER to request such information from

other states.

Upon receipt of this information, the employer should determine (using CDL FORM

INITIAL QUALIFY) if the employee is qualified to operate a CMV. The employer should

then use PENNDOT FORM DL-503 (or obtain an account with PennDOT to access such

information on-line) at least once every twelve months to determine that this employee

remains qualified to operate CMVs using CDL FORM QUALIFY.

Over …

PSATS CDL PROGRAM

CMV/CDL DQF CONTINUED…

b. Review past safety history. The new employer should use CDL FORM HISTORY to

obtain information about this employee’s safety performance history from all CMV

employers from the past three years within 30 days of hire. If an applicant does not have

any CMV experience in the past three years, the new employer must check the box in the

bottom paragraph indicating why no request for such information was made.

c. Review past test results. The new employer should use CDL FORM RESULTS to obtain

information about the new employee’s CDL drug and alcohol test results from all

employers for whom that employee performed CDL activities in the past three years

within 30 days of hire for any applicant for employment that will require the use of a

CDL vehicle. With respect to any employee who violated a DOT drug and alcohol

regulation, documentation of the employee's successful completion of return-to-duty

requirements (including follow-up tests) must also be obtained. If a previous employer

does not have information about the return-do-duty process, the new employer must seek

to obtain this information directly from the employee. If an applicant does not have any

CDL experience in the past three years, the new employer must check the box in the

bottom paragraph indicating why no request for such information was made.

5. Obtain employee’s signature acknowledging receipt of employer’s personnel policy

regarding CDL drug and alcohol testing. Each employee who will operate CDL vehicles

shall participate in the employer’s CDL drug and alcohol testing program and must sign CDL

FORM POLICY indicating they have received a copy of the employer’s CDL employee drug

and alcohol testing policy. This form must be permanently retained in the employee’s file.

Employers should then use CDL FORM ROSTER to add a new CDL employee to this

employer’s list of employees covered by its random drug and alcohol testing policy.

6. Pennsylvania New Hire Report and Federal New Hire Report (I-9) must both be filed as

appropriate: the Pa. New Hire Report must be sent to the state as indicated. Further, all

federal I-9 forms must be kept either for three years after the date of hire, or for one year

after employment is terminated, whichever is later.

7. All applicants for CMV employment must be given the information contained in GUIDANCE

- RIGHT TO REVIEW RESPONSES from previous employers at time of application. All applicants

should also be given the PennDOT form DISQUALIFICATIONS AND TRAFFIC OFFENSES fact

sheet detailing how they can be disqualified from operating CMVs.

8. Obtain employee’s signature acknowledging receipt of annual training, if any, using

CDL FORM TRAIN. These forms should also be retained in the employee’s file.

9. Notification of Suspension. Any employee whose driver’s license is suspended, revoked,

canceled, or if the driver is otherwise disqualified from driving, must notify each employer

by the end of the next business day following receipt of the notice of suspension, revocation,

cancellation, lost privilege or disqualification.

###

CMV/CDL Driver’s Qualification File

Time-of-Hire Documents Checklist

PSATS CDL Form Hiring DQF

Driver’s Name: _________________________________________

Driver license #: _________________________________________

Hire Date: _____________________________________________

Optional records when hiring municipal CMV driver (required records for hiring private sector CMV driver): Employment

Application

(Form APPLY)

Driving record

inquiry

(PennDOT

DL-503)

Initial driving

record review

(Form

QUALIFY)

Request past

test results

(Form

RESULTS)

Response(s)

received for

Form

RESULTS

Request past

safety history

(Form

HISTORY)

Response(s)

received for

Form

HISTORY

Medical

Examiners

Certificate

Expiration

Date *

Required records when hiring a municipal or private sector CMV driver: PA New Hire

Form

Federal I-9

Form

Required records when hiring any CDL driver: Date of

negative pre-

CDL drug test

CDL employee

testing policy

(Form

POLICY)

Name of drug/alcohol testing

program for this CDL

employee

NOTE: Put the date when any of these forms is added to this driver qualification file.

* = Medical examiners certificate not required for Pa. local government employees.

This form and any of the above-listed items must be kept for duration of CDL employment plus three years.

CMV/CDL Driver’s Qualification File

Annual Employment Documents Checklist

PSATS CDL Form Annual DQF

Driver’s Name: _________________________________________

Driver license #: _________________________________________

Hire Date: _____________________________________________

Optional records for continuing municipal CMV employment (required for private sector CMV employee): Next calendar year of

employment

Make driving record

inquiry to PennDOT

every 12 months

Employers’ review of

employee’s PennDOT

driving record (Form

QUALIFY)

Records required for continuing CDL employment: Next calendar year of

employment

Notice of conviction,

if any (Form

CONVICTION)

Accident reports, if

any (Form

ACCIDENT)

Changed CDL

employee testing

policy? (Form

POLICY)

Medical Examiners

Certificate Expiration

Date *

Name of drug/alcohol

testing program for

this CDL employee

NOTE: Put the date in the box when any of these forms is added to this driver qualification file.

* = Medical examiners certificate not required for local government CDL employees.

However, if this is otherwise required as a condition of employment, employer must keep track of expiration date.

Instructions for Completing the Form

ê Unless noted as optional, all required information must be included on the form.

ê Please type or print legibly in black or blue ink. ê This form may be duplicated.

FEIN: Federal Employer Identification Number Employer Name: Legal name of the employer Contact Name: Person authorized to answer questions on the

New Hire Report (this should be someone from the employer)

Contact Phone Number: Phone number for the contact person Employee Social Security Number:

The number assigned by the Social Security Administration

Date of Birth: Optional Item – date of birth for the new hire Date of Hire: The first day the new hire performs services for

wages Employee Name: First, Middle, and Last name of the new hire Employee Address: Permanent address of the new hire êê Pennsylvania New Hire Reports may be submitted through the mail or via

FAX. Mailing Address: Commonwealth of Pennsylvania

New Hire Reporting Program PO Box 69400 Harrisburg, PA 17106-9400

FAX Number: 717-657-HIRE 717-657-4473 1-866-748-4473 (TOLL FREE)

Customer Service Telephone Number:

1-888-PAHIRES 1-888-724-4737

217 COMMONWEALTH OF PENNSYLVANIA

New Hire Reporting Form

Required Employer Information FEIN: Please mail or fax to:

Employer Name: Commonwealth of Pennsylvania New Hire Reporting Program

Address: P. O. Box 69400 Harrisburg, PA 17106-9400

Fax: 717-657-HIRE (717-657-4473)1-866-748-4473 (TOLL FREE) Contact Name:

Phone: 1-888-PAHIRES (1-888-724-4737) Contact Phone #: (for questions only)

This form can be duplicated

Required Employee Information (Please type or print legibly in black or blue ink.)

Employee Social Security # Date of Birth (mm/dd/yyyy) optional Date of Hire (mm/dd/yyyy)

Name (first) (middle) (last)

Address

City State Zip



Address

City State Zip



Address

City State Zip

New Lending a HandHire to Pennsylvania's

Reporting Children

Commonwealth of Pennsylvania Department of Labor and Industry Center for Workforce Information and Analysis

Pennsylvania New Hire Reporting Program - 5REVISED 07/2010

Q: What is a disqualification?A: A disqualification is the temporary or permanent withdrawal of a person’s privilege to operate a commercial motor vehicle (CMV).

Q: How long can a disqualification last?A: The length of a disqualification depends on the violation as well as the driver’s record. It can be for a minimum of 60 days or as long as a lifetime.

Q: How does a Commercial Driver become disqualified?A: A disqualification can result from a single conviction for a MAJOR OFFENSE, an accumulation of SERIOUS TRAFFIC OFFENSES or for other

specific violations, i.e. violations of railroad-highway grade crossings.

Q: What is a major offense?A: The following chart lists the violations that are defined as major offenses for CDL holders. Most of these violations will result in the disqualification

of your commercial driving privilege regardless of the type of vehicle you are driving (CMV and non-CMV). The disqualification period that a majoroffense carries depends on the offense and the type of vehicle you are driving. Two major offenses result in a lifetime disqualification.

Lifetime

Federal Description PA Code Section Vehicle TypeLength of

Disqualificationfor First Offense

Driving under the influence of alcohol or controlledsubstance.

Refusing to submit to chemical testing.

Leaving the scene of an accident.

Using a vehicle to commit felony.

Using a vehicle in the commission of a felonyinvolving manufacturing, distributing or dispensing acontrolled substance.

Driving a CMV while the driver’s CDL is revoked,suspended, cancelled or disqualified.

Causing a fatality through the negligent operation ofa CMV.

3731(i)3802

16131547

37433745

Various CrimesCode Offenses

13a10 13a1413a19 13a3013a36

1606(c)(1)1543(a)(b)

3742 37352503 2504

CMV or Personal vehicle





CMV Only

CMV Only

1 Year3 Years with Hazmat






Major Offenses

Q: What is a serious traffic offense (STO)?

A: The following chart lists the violations that are defined as serious traffic offenses. If you are convicted of any 2 of these serious traffic offenseswithin a 3 year period, you will be disqualified from driving a CMV for 60 days. If you are convicted of 3 or more serious traffic offenses within a3 year period, you will be disqualified from driving a CMV for 120 days. Most of these violations must occur in a CMV to count as a STO.However, there are some exceptions as noted below.

DISQUALIFICATIONS AND TRAFFIC OFFENSESFACT SHEET

June 2012

Federal Description PA Code Section Vehicle Type

Exceeding maximum speed limit 15 mph or more.

Driving recklessly, as defined by state or local law.

Making improper or erratic traffic lane changes.

Following the vehicle ahead too closely.

Duty of driver in construction and maintenance areasor on highway safety corridors. (This violation is anSTO under PA law)

Violating state or local law relating to motor vehicletraffic control arising in connection with a fatalaccident.

Driving a CMV without obtaining a CDL, driving aCMV without a valid CDL in the driver’s possession,driving a CMV without the proper class and/orendorsements.

3362 3365(b)

3736

3304 3305 3306(a)(1)3306(a)(2) 3306(a)(3) 33073309(1) 3309(2) 3309(4)

3310

3326

3714(b)All other moving violations

1606(a)1501(a)

CMVPersonal vehicle (only if the violation occurred ina work zone or school zone)


CMV

CMV

CMV

CMV or personal vehicleCMV only

CMV

Serious Traffic Offenses

CMVHazardous Grades 3365(c)

Q: Are there other violations that will result in a disqualification?A: Yes. Railroad-highway grade crossing violations, out-of-service order violations and being determined to constitute an imminent hazard.

Q: What is the disqualification period for a railroad-highway grade crossing offense?A: A conviction of a railroad-highway grade offense will result in the automatic disqualification of your privilege to operate a CMV if the offense

occured while operating a commercial vehicle. The length of the disqualification is 60 days for the 1st offense, 120 days for the 2nd offensewithing a 3 year period and 1 year for a 3rd or subsequent offense. The following chart lists the various railroad-highway grade crossingoffenses.

Federal Description PA Code Section Vehicle Type

The driver is not required to always stop, but fails to slow down and check that tracks areclear of an approaching train.

The driver is not required to stop, but fails to stop before reaching the crossing, if the tracksare not clear.

The driver is always required to stop, but fails to stop before driving onto the crossing.

The driver fails to have sufficient space to drive completely through the crossing withoutstopping.

The driver fails to obey a traffic control device or the direction of an enforcement official atthe crossing.

The driver fails to negotiate a crossing because of insufficient undercarriage clearance.

3342(g)

3342(g)

3342(a) 3342(e)

3341(b)(2) 3342(b)

3341(a) 3341(b)(1)

3343(a) 3343(c) 3343(d)

CMV

CMV

CMV

CMV

CMV

CMV

Railroad-Highway Grade Crossing Offenses

Q: What is the disqualification period for violating an out-of-service order?A: This is a tiered disqualification period. If a driver is convicted of violating an out-of-service order while transporting non-hazardous materials, 1st

offense - 1 year, 2nd or subsequent offense in a ten year period - 3 years. If a driver is transporting hazardous materials or operating a vehicledesigned to transport 16 or more passengers, including the driver, 1st offense - 2 years, 2nd or subsequent offense in a ten year period - 5years.

Q: What is an imminent hazard?A: The Federal definition of an imminent hazard is the existence of a condition that presents a substantial likelihood that death, serious illness, severe

personal injury, or a substantial endangerment to health, property, or the environment may occur before the reasonably foreseeable completiondate of a formal proceeding begun to lessen the risk of that death, illness, injury or endangerment.

Q: Who determines an imminent hazard?A: The Assistant Administrator or his/her designee from the Federal Motor Carrier Safety Administration (FMCSA).

Q: What is the length of disqualification imposed if a CDL holder is determined to be an imminent hazard?A: The period of disqualification should not exceed 30 days. However, the disqualification remains in effect until PennDOT is notified by the FMCSA

Assistant Administrator of his/her designee.

Q: Can an imminent hazard disqualification be appealed?A: Yes. The appeal can be filed with the Assistant Administrator, Adjudications Counsel, Federal Motor Carrier Safety Administration (Room 8217),

400 Seventh Street, SW., Washington, DC 20590.

Q: Do violations that occur out of state impact my Pennsylvania driving privilege?A: Yes. Out-of-state violations are treated as if they occured in Pennsylvania.

Q: Does the acceptance of Accelerated Rehabilitive Disposition (ARD) count towards disqualification?A: Yes. ARD participation is considered a conviction for sanctioning of CDL holders.

Q: Will an administrative per se suspension for a DUI arrest in another state affect my PA driving privilege?A: Yes. CDL holders that receive an administrative per se suspension will have their commercial driving privilege disqualified.

Q: Can a disqualified CDL driver operate a non-commercial vehicle?A: Yes. If a driver holds a CDL license or permit and is only disqualified from operating a CMV, the person is eligible to apply for a non-commercial

driver’s license to drive a non-commercial motor vehicle during the disqualification. An application to apply for a non-commercial license will beenclosed with the disqualification notice.

Q: How do I get my CDL privilege restored?A: In addition to serving the time required to the disqualification, you will have to pay a restoration fee to PennDOT before your CDL will be returned.

Q: How can I obtain additional information?A: You may write to the following address:

PennDOTP.O. Box 68618 OR CALL

Harrisburg, PA 17106-8618

Monday through Friday during the hours of8:00 a.m. - 5:00 p.m., Eastern Time

1-800-932-4600TDD: 1-800-228-0676

in state1-717-412-5300

TDD: 1-717-412-5380

out of state

The PSATS CDL Program acknowledges enrollment of the following

driver in our qualified testing consortium:

____________________________________________________

Federal law exempts local government employees from needing a medical card for interstate

commerce, while PA Code Title 67 Section 231.8(6) exempts local government

employees from needing a medical card for intrastate commerce.

Other important information for the driver is contained on the reverse.

PSATS CDL Program, 4855 Woodland Drive, Enola, PA, 17025

(P) 717-763-0930, (E) [email protected]



____________________________________________________









____________________________________________________







Important Driver Information Regarding Post-accident Testing

Section 49 CFR 382.303 requires the driver of a commercial motor vehicle involved in an accident (whether it involves

another vehicle or not) to take: (1) a DRUG AND ALCOHOL test if a fatality occurred; or (2) a DRUG AND ALCOHOL test if the

driver receives a citation for a moving traffic violation within 8 hours of the accident and either (a) any involved vehicle was

towed or (b) someone injured in the accident receives medical treatment away from the scene; or (3) a DRUG test if the driver

receives a citation for a moving traffic violation between 8 and 32 hours after the accident and either (a) any involved vehicle

was towed or (b) someone injured in the accident receives immediate medical treatment away from the scene.

Your employer is to identify here the name, address, and phone number of your nearest 24/7 PSATS CDL Program test site:

____________________________________________________________________________________________________

Phone #: _______________________________________. Should you need to take a post-accident test as defined above, you

must immediately contact this facility to inform them of your pending arrival so they may be ready. Unless medical attention

is required, you must take any alcohol test within 8 hours of the accident and you must take any any drug test within 32

hours of the accident. If unable to meet either of these time frames, the employer shall maintain a record in the employee’s

file stating the reason the test was not administered for submittal to any authorize authority upon request.









____________________________________________________________________________________________________














____________________________________________________________________________________________________






COMMERCIAL MOTOR VEHICLE

DRIVER ACCIDENT LOG

Today’s Date: _____________________________________________

Driver’s Full Name: ________________________________________

Driver License #: __________________________________________

Federal regulations at 49 CFR 390.15(b) require all employers to maintain at least the following

information regarding any accident (as defined below) of this driver for three years, as well as all other

accident reports required by State or other governmental entities or insurers.

The regulations at 49 CFR 390.5 define an “accident” as “an occurrence involving a commercial

motor vehicle operating on a highway in interstate or intrastate commerce which results in: (i) A fatality;

(ii) Bodily injury to a person who, as a result of the injury, immediately receives medical treatment away

from the scene of the accident; or (iii) One or more motor vehicles incurring disabling damage as a result

of the accident, requiring the motor vehicle(s) to be transported away from the scene by a tow truck or

other motor vehicle.”

The term accident does not include: (i) an occurrence involving only boarding and alighting from

a stationary motor vehicle; or (ii) an occurrence involving only the loading or unloading of cargo.

Date of accident: ______________________________

Municipality and state in which accident occurred: ____________________________________

Number of people injured: ________

Number of fatalities: ________

Were hazardous materials, other than fuel spilled from the fuel tanks of motor vehicles involved in the

accident, released? If “yes”, identify such materials here: ______________________________

_____________________________________________________________________________

PSATS CDL Program Form ACCIDENT

EMPLOYER’S NOTICE OF

CDL DRIVER’S CONVICTION

Today’s Date: _____________________________________________

Driver’s Full Name: ________________________________________

Driver License #: __________________________________________

Federal regulations at 49 CFR 383.31 require employees who have a CDL and operate commercial

motor vehicles to notify their current employer(s) and the state(s) which issued the license of any

conviction for violating, in any type of motor vehicle, a motor vehicle law (except parking). The

notification must be made (using this form) within 30 days of the date of that conviction.

Date of conviction: ______________________________

Location of offense: _____________________________

Identification of the specific laws violated for which I was convicted:

__________________________________________________________________________

__________________________________________________________________________

List any suspension, revocation, or cancellation of driving privileges resulting from such conviction(s);

__________________________________________________________________________

These violations did ( ) / did not ( ) occur while I was driving a commercial motor vehicle.

I certify by signing below that this is a true and complete

account of the events regarding this conviction.

__________________________________________________ Driver’s Signature

PSATS CDL Program Form CONVICTION