Physical Fitness Certificate Template


Updated May 2014
(Insert employer name or place on letterhead / Return to employer when complete)
Physical Fitness Certificate
School Bus Driver
Special Purpose Bus Operator (special purpose bus capacity greater than 15 passengers)
School Bus Monitor (not required)
Indiana Code 20-27-8-1, in part states, (a) an individual may not drive a school bus for the transportation of students or be
employed as a school bus monitor unless the individual satisfies the following requirements:
(7) Possess the following required physical characteristics:
(A) Sufficient physical ability to be a school bus driver, as determined by the state school committee. (Title 575 IAC 1-8)
(B) Possession and full normal use of both hands, both arms, both feet, both legs, both eyes, and both ears.
(C) Freedom from any communicable disease that:
(i) may be transmitted through airborne or droplet means; or
(ii) requires isolation of the infected person under 410 IAC 1-2.3.
(D) Freedom from any mental, nervous, organic, or functional disease which might impair the person’s ability to properly operate
a school bus.
(E) Visual acuity, with or without glasses, of at least 20/40 in each eye and a field of vision with 150 degree minimum and with
depth perception of at least 80%.
Indiana Code 20-27-9-5(c)(1), in part , states if the special purpose bus has a capacity of more than fifteen passengers, the
operator meet the requirements for a school bus driver set forth in I.C. 20-27-8-4
Physical Fitness Certificate Requirement
An individual who is or intends to become a school bus driver must obtain a physical examination certificate stating that the
individual possesses the physical characteristics required by section 1(a)(7) of this chapter. The certificate shall be made by an
individual who is registered in the Federal Motor Carrier Safety Administration's National Registry of Certified Medical
Examiners after the certified medical examiner has conducted a physical examination of the school bus driver or prospective
school bus driver. The school corporation shall determine how the certified medical examiner who is to conduct the physical
examination is chosen and who must pay for the physical examination.. (I.C. 20-27-8-4)
I certify that _________________________________possesses the physical characteristics required by I.C. 20-27-8-1 to be a
school bus driver, school bus monitor, or special purpose bus operator. The certificate of examination shall be filed with the
school corporation or employer not more than seven days after the examination. (I.C. 20-27-8-5)
Certified medical examiner signature
Printed name
Certified medical examiner national registry ID number
Date of examination
This physical examination expires 24 months from the above date. (I. C. 20-27-8-5)
Certified medical examiner’s address and telephone number


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