1. (a) Annual Physical Examination. Each school bus driver shall undergo and successfully complete an annual physical examination. The results of the examination shall be noted on the Texas Department of Public Safety form, Medical Examination Report for School Bus Drivers dated for the current school year, which lists those physical and mental conditions for which the examining physician is directed to disqualify an applicant according to Figure 1: §14.1(1) of this title (relating to Appendix).

2. (b) Physical qualifications. A person is physically qualified to drive a school bus if that person:

   1. (1) has no loss of a foot, a leg, a hand, or an arm;
   2. (2) has no impairment in the use of a hand, an arm, a foot, a leg or any other structural defect or other limitation which interferes with his/her ability to control and safely operate a commercial motor vehicle;
   3. (3) has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control;
   4. (4) has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure;
   5. (5) has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely;
   6. (6) has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a commercial motor vehicle safely;
   7. (7) has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with his/her ability to control and operate a commercial motor vehicle safely;
   8. (8) has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a commercial motor vehicle;
   9. (9) has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his/her ability to operate a commercial motor vehicle safely;
   10. (10) has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber;
   11. (11) first perceive a forced whispered voice in the better ear at not less than five feet with or without the use of a hearing aid or, if tested by use of an audiometric device, does 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 when the audiometric device is calibrated to American National Standard (formerly ASA Standard) Z24.5-1951. (This requirement does not apply to an otherwise qualified person with a hearing disability to be employed as a bus driver for vehicles used to transport hearing impaired students or persons.);

   12. (12) Does not use a controlled substance identified in 21 CFR 1308.11, Schedule 1, an amphetamine, a narcotic, or any other habit-forming drug. Exception - A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who:

       1. (A) is familiar with the driver's medical history and assigned duties;
       2. (B) has advised the driver that the prescribed substance or drug will not adversely affect the driver's ability to safely operate a commercial motor vehicle; and
       3. (C) has no current clinical diagnosis of alcoholism.

3. (c) Physical Exam. Instructions for performing and recording physical examinations:

   1. (1) The medical examination shall be performed and its results shall be recorded, substantially in accordance with the following instructions and the form in Figure 1: 37 TAC §14.1(1) (relating to Appendix). The examining physician should review these instructions before performing the physical examination. Answer each question yes or no where appropriate. The examining physician should be aware of the rigorous physical demands and mental and emotional responsibilities placed on the driver of a commercial motor vehicle. In the interest of public safety, the examining physician is required to certify that the driver does not have any physical, mental, or organic defect of such a nature as to affect the driver's ability to safely operate a commercial motor vehicle. The physician must date and sign his/her findings upon completion of the examination and furnish the original to the motor carrier employer.
   2. (2) The medical examination shall be performed by a physician, advanced practice nurse or physician assistant. An ophthalmologist, optometrist, or therapeutic optometrist may perform only that portion of examinations pertaining to visual acuity, field of vision, and ability to recognize colors as specified in subsection (b)(10) of this section.

   3. (3) The purpose of this history and medical examination is to detect the presence of physical, mental, or organic defects of such a character and extent as to affect the applicant's ability to operate a commercial motor vehicle safely. History of certain defects may be cause for rejection, or indicate the need for making certain laboratory tests, or a further and more stringent examination. Defects may be recorded which do not, because of their character or degree, indicate that certification of physical fitness should be denied. However, these defects should be discussed with the applicant and he/she should be advised to take the necessary steps to ensure correction, particularly of those which if neglected, might lead to a condition likely to affect his/her ability to drive safely. The examination should be made carefully and at least as completely as detailed in subparagraphs (A)-(R) of this paragraph.

      1. (A) General appearance and development. Note marked overweight. Note any posture defect, perceptible limp, tremor, or other defects that might be caused by alcoholism, thyroid intoxication, or other illness. Both State and Federal Motor Carrier Safety Regulations provide that no driver shall use a narcotic or other habit-forming drug.
      2. (B) Head-Eyes. When other than the Snellen chart is used, the results of such test must be expressed in values comparable to the standard Snellen test. If the applicant wears corrective lenses, these should be worn while the applicant's visual acuity is being tested. If appropriate, indicate on the Medical Examiner's Certificate by checking the box, "Qualified only when wearing corrective lenses." In recording distance vision, use 20 feet as normal. Record all vision as a fraction with 20 feet as the numerator and the smallest type read at 20 feet as the denominator. Note ptosis, discharge, visual fields, ocular muscle imbalance, color blindness, corneal scar, exophthalmos, or strabismus, uncorrected by corrective lenses. Monocular drivers are not qualified to operate commercial motor vehicles under existing State of Texas Motor Carrier Safety Regulations, unless granted a waiver. If the driver habitually wears contact lenses or intends to do so while driving, there should be sufficient evidence to indicate that he/she has good tolerance and is well adapted to their use. The use of contact lenses should be noted on the record.
      3. (C) Ears. Note evidence of mastoid or middle ear disease, discharge, symptoms of aural vertigo, or Meniere's Syndrome. When recording hearing, record distance from patient at which a forced whispered voice can first be heard. If audiometer is used to test hearing, record decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz.
      4. (D) Throat. Note evidence of disease, irremediable deformities of the throat likely to interfere with eating or breathing, or any laryngeal condition which could interfere with the safe operation of a motor vehicle.
      5. (E) Thorax--heart. Stethoscopic examination is required. Note murmurs and arrhythmias and any past or present history of cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, enlarged heart, or congestive heart failures. Electrocardiogram is required when findings so indicate.
      6. (F) Blood pressure. Record with either a spring or mercury column type of sphygmomanometer. If the blood pressure is consistently above 160/90 mm. Hg., further tests may be necessary to determine whether the driver is qualified to operate a commercial motor vehicle.
      7. (G) Lungs. If any lung disease is detected, state whether active or arrested. If arrested, give your opinion as to how long it has been quiescent.
      8. (H) Gastrointestinal system. Note any diseases.
      9. (I) Abdomen. Note wounds, injuries, scars, or weakness of muscles of abdominal walls sufficient to interfere with normal function. Any hernia should be noted if present. State how long and if adequately contained by a truss.
      10. (J) Abnormal masses. If present, note location, if tender, and whether or not the applicant knows how long they have been present. If the diagnosis suggests that the condition might interfere with the control and safe operation of a commercial motor vehicle, more stringent tests must be made before the applicant can be certified.
      11. (K) Tenderness. When noted, state where most pronounced and the suspected cause. If the diagnosis suggests that the condition might interfere with the control and safe operation of a commercial motor vehicle, more stringent tests must be made before the applicant can be certified.
      12. (L) Genito-urinary. Urinalysis is required. Acute infections of the genito-urinary tract, as defined by local and state public health laws, indications from urinalysis of uncontrolled diabetes, symptomatic albumin-urea in the urine or other findings indicative of health conditions likely to interfere with the control and safe operation of a commercial motor vehicle, will disqualify an applicant.
      13. (M) Neurological. If positive Rhomberg is reported, indicate degrees of impairment. Pupillary reflexes should be reported for both light and accommodation. Knee jerks are to be reported absent only when not obtainable upon reinforcement and as increased when the foot is actually lifted from the floor following a light blow on the patella, sensory vibratory and positional abnormalities should be noted.
      14. (N) Extremities. Carefully examine upper and lower extremities. Record the loss or impairment of a leg, foot, toe, arm, hand, or fingers. Note any and all deformities, the presence of atrophy, semiparalysis or paralysis, or varicose veins. If a hand or finger deformity exists, determine whether sufficient grasp is present to enable the driver to secure and maintain a grip on the steering wheel. If a leg deformity exists, determine whether sufficient mobility and strength exist to enable the driver to operate pedals properly. Particular attention should be given to and a record should be made of any impairment or structural defect which may interfere with the driver's ability to operate a motor vehicle safely.
      15. (O) Spine. Note deformities, limitation of motion, or any history of pain, injuries, or diseases, past or presently experienced in the cervical or lumbar spine region. If findings so dictate, radiological and other examinations should be used to diagnose congenital or acquired defects; or spondylolithesis and scoliosis.
      16. (P) Recto-genital studies. Diseases or conditions causing discomfort should be evaluated carefully to determine the extent to which the condition might be handicapping while lifting, pulling, or during periods of prolonged driving that might be necessary as part of the driver's duties.
      17. (Q) Laboratory and other special findings. Urinalysis is required, as well as such other tests as the medical history findings upon physical examination may indicate are necessary. A serological test is required if the applicant has a history of luetic infection or present physical findings indicate the possibility of latent syphilis. Other tests as deemed advisable may be ordered by the examining physician.
      18. (R) Diabetes. If insulin is necessary to control a diabetic condition, the driver is not qualified to operate a commercial motor vehicle. If mild diabetes is noted at the time of examination and it is stabilized by use of a hypoglycemic drug and diet that can be obtained while the driver is on duty, it should not be considered disqualifying. However, the driver must remain under adequate medical supervision.

Source Note:The provisions of this §14.12 adopted to be effective October 7, 1996, 21 TexReg 9243; amended to be effective July 7, 1999, 24 TexReg 5023; amended to be effective February 6, 2001, 26 TexReg 1160.