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'~ EMPLOYER'S REPORT OF MEDICAL EXAM FAILURE <br />- C, alifomia Law (Section 14606(b), Vehicle Code) requires employers to report to the Department driver~ they employ who fail to <br /> qualify for a medical certificate on reexamination. <br /> <br /> For your convenience, this form may be used to report a driver who fails to qualify for a medical certificate. <br /> <br /> If additional copies of this form are needed, you may duplicate as many copies as you wish. Mall completed forms to the Driver <br /> Safety Review Unit, P. O. Box 825890, Sacramento, CA 94290-0001. <br /> <br /> Please complete the following information, if known, and attach a copy of the drivers medical evaluation, if available. <br /> <br />I am reporting this driver as required by Section 14606(b) of the Califomia Vehicle Code. <br /> <br /> mllJRE DATE <br /> <br /> EMPLOYER'S REQUEST FOR REEXAMINATION OF DRIVER <br /> <br />Section 13800 of the Califomia Vehicle Code allows the Department of Motor Vehicles to investigate the qualifications of a driver <br />when it appears necessary. <br /> <br />Occasionally an employer requests the Department of Motor Vehicles to reevaluate a driver's qualffications because the driver's <br />condition or behavior may impair his or her ability to safely operate a motor vehicle. <br /> <br />To have a ddver's qualifications reevaluated by the department, please identify the ddver by filling out the driver information above. <br />Briefly describe below the condition or actions of the driver which make you believe a reexamination by the department is <br />necessary (use reverse side if needed). <br /> <br /> <br />