SELF AUDIT | FORM - Transportation Safety Systems

This complimentary Compliance Audit Tool is available for your use at any time and free of charge. By entering the needed information, you will have the results automatically sent to you with a PDF report attached for storage. Please provide the requested information and then when you receive the report, either print and store or electronically save the information in your digital files as needed. If at any time you would like TSS to perform a complete digitization and Audit, please let us know and we can help you get on the road to complete compliance.

AUDIT

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Who is this From?
- Transportation Safety Systems
Audit Date*
MM slash DD slash YYYY
Company Name audit is being conducted for:*

This information is used to sort only.
Please Enter Employee/Applicant/File Name:*
First Last
Please enter the file name you wish to Audit.
Do you want to send this audit result to someone other than our self?*
- No
- Yes
Please Enter Auditor Name:*
First Last
This is your name.
Please Enter Auditor Email:*
Enter Email Confirm Email

Please enter your preferred email address for a copy of your audit to me mailed to.
Please enter Recipient Name:*
First Last
This is who you will be submitting the final audit to when it has been completed.
Please Recipient Email:*
Enter Email Confirm Email

When completed, an email with an attached PDF will be sent to this address. This PDF can be printed for paper storage file systems or migrated for electronic storage file systems, and will be titled "COMPLIANCE AUDIT (file name)"
What Type of Audit would you like to do?*
- DOT Qualification File Audit
- Personnel File Audit
- Payroll File Audit
- Health File Audit
- Training File Audit
- Random File Audit
- Summary Audit Finding and Documentation
- Renewals File Audit
DOT Qualification File Audit
Both the Driver Qualification and Safety Performance History Files must be retained for as long as the safety-sensitive individual is employed by the company, and for three years thereafter. The following documentation may be discarded from the Driver Qualification File three years from the date of execution: Annual List of Violations, Annual Inquiry to Sate Agencies, Annual Review of Driving Record, Medical Examiner’s Certificate, Safety Performance Evaluation Certificate (if applicable)
Please select the items that are present in the file:*
- None
- APP (Application for Employment)
- CDL (Commercial Driver License) or EHCDL (Enhanced Commercial Driver License)
- MEC (Medical Examiner Certification/Card)
- MVR (Motor Vehicle Record)
- COC (Chain of Custody form for pre-employment drug test)
- DTR (Drug Test Results)
- RT (Road Test or Equivalent, some companies accept a valid CDL)
- CFR (Cfr 49 Previous employer request for each CDL employer listed on APP have been sent at least once)
- NRCME (National Registry of Certified Medical Examiners search results)
- HOS (Previous Seven Days statement)
- Certificate of Compliance Stating only one license will be held
- FMCSR Receipt for information
- DAP (Drug and Alcohol Policy and educational materials receipt)
Please select the items that are are needed to complete the file:*
- None
- APP (Application for Employment)
- CDL (Commercial Driver License) or EHCDL (Enhanced Commercial Driver License)
- MEC (Medical Examiner Certification/Card)
- MVR (Motor Vehicle Record)
- COC (Chain of Custody form)
- DTR (Drug Test Results)
- RT (Road Test or Equivalent, some companies accept a valid CDL)
- CFR (Cfr 49 Previous employer request for each CDL employer listed on APP have been sent at least once)
- NRCME (National Registry of Certified Medical Examiners search results)
- HOS Previous Seven Days statement
- Certificate of Compliance Stating only one license will be held
- FMCSR Receipt for information
- DAP (Drug and Alcohol Policy and educational materials receipt)
Application Information
Verify True and Correct Statement present on the application.*
- Yes
- No
Application indicates Driver held another license within three years.*
- Yes
- No
Is previous License information present in file?*
- Yes
- No
Does Application cover the previous seven seven years of residency?*
- Yes
- No
Does the Application cover the appropriate employment history?*
- Yes
- No
Three years for all employment, ten for Commercial driving jobs.
Does Application (or MVR) Indicate any collisions or citations?*
- Yes
- No
Does Application (or MVR) identify which state these citations or collisions were in?*
- Yes
- No
Does drive experience total miles driven calculate correctly for time period stated?*
- Yes
- No
Do you have any reason to suspect this application needs additional information added?*
- Yes
- No
Any Problems in this section?*
- Yes
- No
Please explain problems.*
CDL Information
License Number on Document*
CDL Expiration Date*
MM slash DD slash YYYY
State of Issue*
State / Province / Region
Is this CDL or DL from out of your state of operation?*
- No
- Yes
New State residents have 90 days to transfer a CDL or DL. Would you like to send yourself a reminder?*
- Yes Please.
- No Thanks.
Date of Birth*
MM slash DD slash YYYY
Gender listed on CDL*
- Male
- Female
CDL Class*
- Class A
- Class B
- Class C
- Permit
- Non CDL Driver
Endorsements*
- (P1) Passenger
- (S) School Bus
- (H) Hazmat
- (M) Motorcycle
- (T) Doubles/Triples
- (N) Tank Vehicle
- (X) Tanker and Hazardous Materials
- Other
Please Explain Other*
Restrictions*
- None
- (U) Intrastate Only
- (C) Corrective Lenses
- (L) Air Brakes
- (V) Waiver (medical)
- (E) No manual Transmission
- Other
Please Explain Other*
Does the state you are auditing in offer online research tools?*
- Yes
- No
Some states have online tools that allow free check of current license status.
Is drivers license research status present in file?*
- Yes
- No
Some states have online tools that allow free check of current license status. If this item is present, note it here.
Upload front of License here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
MEC Information
MEC Expiration Date*
MM slash DD slash YYYY
MEC Inter-State or Intra-State*
- Inter-State
- Intra-State
MEC Expiration date matches MVR*
- Yes
- No
- MVR Does not have information listed
Verification of compliant medical examiner in file.*
- Yes
- No
Date of Issue and Date of Expiration present on MEC card.*
- Both are present
- One or more is missing
MEC exception*
- None
- Corrective Lenses
- Waiver/Exemption Certificate
- Hearing Aid
- Driving within an exempt intracity zone
- Qualified by operation of 49 CFR 391.64
Type of Waiver required*
- Diabetes
- Vision
- Amputee/Loss of Limb
Waiver/Exemption document pesent*
- Present
- Not Present
Upload front of MEC here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
MVR Information
MVR Expiration Date*
MM slash DD slash YYYY

MVR expires 12 Months after pull date. Add 12 months to date of document.
MVR Certification matches the MEC (Medical Examiner Certificate) Certification.*
- Both are Inter-State
- Both are Intra-State
- They do not match
Upload front of MVR here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
COC Information
COC has been properly marked with FMCSA panel.*
- Yes
- No
COC properly marked as "Pre-Employment".*
- Yes
- No
COC has correct company name on it.*
- Yes
- No
COC has been correctly signed by Donor.*
- Yes
- No
Upload COC here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
DTR Information
DTR is in correct employee file*
- Yes
- No
DTR is NEGATIVE for drugs in system.*
- Yes
- No
DTR is correctly marked FMCSA.*
- Yes
- No
DTR is correctly marked DOT Panel.*
- Yes
- No
DTR is correctly marked Pre-Employment.*
- Yes
- No
DTR is correctly marked with employer name.*
- Yes
- No
Any anomalies such as Dilute noted on DTR?*
- Yes
- No
Please explain*
Is documentation present indicating when employee was entered into the drug pool?*
- Yes
- No
CRITICAL ITEM!!
Enter Enrollment Date*
MM slash DD slash YYYY
Upload DTR here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
RT Information
Does this motor carrier require a road test?*
- Yes
- No
Was driver identified as having the skills necessary?*
- Yes
- No
Were the miles properly listed for the Road Test?*
- Yes
- No
Does road test identify equipment type tested in?*
- Yes
- No
Is the Road Test properly signed?*
- Yes
- No
Is there an "Equivalent of Road Test" in file?*
- Yes
- No
Upload RT here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
CFR Information
How many CFR 49 items were provided*
- 1
- 2
- 3
- 4
- 5
- 6
Was the #1 CFR sent twice?*
- Yes
- No
Was the #1 CFR response received??*
- Yes
- No
Was the #2 CFR sent twice?*
- Yes
- No
Was the #2 CFR response received?*
- Yes
- No
Was the #3 CFR sent twice?*
- Yes
- No
Was the #3 CFR response received?*
- Yes
- No
Was the #4 CFR sent twice?*
- Yes
- No
Was the #4 CFR response received?*
- Yes
- No
Was the #5 CFR sent twice?*
- Yes
- No
Was the #5 CFR response received?*
- Yes
- No
Was the #6 CFR sent twice?*
- Yes
- No
Was the #6 CFR response received?*
- Yes
- No
Was any documentation NEEDING TO BE sent to FMCSA for failure to respond?*
- Yes
- No
- Possibly
Please Explain
Was any documentation sent to FMCSA for failure to respond?*
- Yes
- No
Office of Drug & Alcohol Policy & Compliance 1200 New Jersey Ave, SE W62-300 Washington, DC 20590 United States ODAPCWebMail@dot.gov Phone: (202) 366-3784 Alt: (800) 225-3784 Fax: (202) 366-3897
Upload CFR here if necessary.
Drop files here or

Max. file size: 20 MB.
Office of Drug & Alcohol Policy & Compliance 1200 New Jersey Ave, SE W62-300 Washington, DC 20590 United States ODAPCWebMail@dot.gov Phone: (202) 366-3784 Alt: (800) 225-3784 Fax: (202) 366-3897
Office of Drug & Alcohol Policy & Compliance 1200 New Jersey Ave, SE W62-300 Washington, DC 20590 United States ODAPCWebMail@dot.gov Phone: (202) 366-3784 Alt: (800) 225-3784 Fax: (202) 366-3897
Any problems in this section?*
- Yes
- No
Please explain problems.*
NRCME Information
NRCME doctor verification document is present in file.*
- Yes
- No
NRCME doctor number is a valid number.*
- Yes
- No
NRCME doctor name matches that listed on MEC card.*
- Yes
- No
Upload NRCME Results here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
HOS Information
Is the Previous Seven Days document correctly completed?*
- Yes
- No
Please Explain*
Is the Previous Seven Days document correctly signed and dated?*
- Yes
- No
Upload Previous Seven Days here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
Certificate of Compliance Information
Does Certificate of Compliance have DL number present?*
- Yes
- No
Is Certificate of Compliance signed and dated correctly?*
- Yes
- No
Upload Certificate of Compliance here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
FMCSR Information
FMCSR receipt is present in file.*
- Yes
- No
FMCSR receipt is signed by employee.*
- Yes
- No
FMCSR receipt is in correct employee file.*
- Yes
- No
Upload FMCSR Receipt here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
DAP Information
DAP receipt for information is present.*
- Yes
- No
DAP receipt for information is signed by employee.*
- Yes
- No
DAP is in correct employee file.*
- Yes
- No
DOT Qualification Notes, requests or special instructions.
Upload DAP Receipt here if necessary.
Drop files here or

Max. file size: 20 MB.
Any problems in this section?*
- Yes
- No
Please explain problems.*
Personnel File
Items present in Personnel File*
- CBC Authorization (Criminal Background Check)
- CBC Response
- PSP Authorization (Pre-Employment Screening Program-FMCSA)
- PSP Report
- MVR Auth Initial (Motor Vehicle Record Authorization-Initial Pull)
- MVR Auth Annual(Motor Vehicle Record Authorization-Annual Pull)
- Code of Conduct or Similar (Employee manual or other document)
- Insurance Company Approval
- Request to Add to Insurance Policy
- Fuel Card or PIN order
Items needed in Personnel File*
- None
- CBC Authorization (Criminal Background Check)
- CBC Response
- PSP Authorization (Pre-Employment Screening Program-FMCSA)
- PSP Report
- MVR Auth Initial (Motor Vehicle Record Authorization-Initial Pull)
- MVR Auth Annual(Motor Vehicle Record Authorization-Annual Pull)
- Code of Conduct or Similar (Employee manual or other document)
- Insurance Company Approval
- Request to Add to Insurance Policy
- Fuel Card or PIN order
Payroll File
Payroll Document Present*
- I9 Present
- W4 Present
- PAN Present (Personell Action Notification)
I9 Document
I9 Document items present
- Document is current (upper right corner expiration)
- I9 signed section 2 with two dates
- I9 list complete
- Documents listed on I9 present in file
- Birthdate listed on I9
- Telephone number listed on I9
I9 Document items needed
- None
- Document is current (upper right corner expiration)
- I9 signed section 2 with two dates
- I9 list complete
- Documents listed on I9 present in file
- Birthdate listed on I9
- Telephone number listed on I9
W4 Document
W4 Document items present*
- Document is current
- Section 1 Completed (name/address)
- Section 2 Completed (SS Number)
- Section 3 Completed (single/married/married filing singly)
- Section 4 Completed (last name differs)
- Section 5 Completed (total allowances)
- Section 6 Completed (additional amount)
- Section 7 Completed (exempt)
- Employee Signature and date
- Section 8 Completed (employer name and address)
- Section 10 Completed (EIN number)
W4 Document items needed*
- None
- Document is current
- Section 1 Completed (name/address)
- Section 2 Completed (SS Number)
- Section 3 Completed (single/married/married filing singly)
- Section 4 Completed (last name differs)
- Section 5 Completed (total allowances)
- Section 6 Completed (additional amount)
- Section 7 Completed (exempt)
- Employee Signature and date
- Section 8 Completed (employer name and address)
- Section 10 Completed (TIN Number)
PAN Document (Personell Action Notification)
PAN Document items Present
- Rate of pay listed on PAN
- Employee status listed on PAN
- Employee department listed on PAN
PAN Document items Needed
- None
- Rate of pay listed on PAN
- Employee status listed on PAN
- Employee department listed on PAN
Health File
Untitled
- First Choice
- Second Choice
- Third Choice
Training File
Training Items Present*
- Enrolled in online training
- Driver On-Boarding course completed
- 101 Course Completed
- 102 Course Completed
- 103 Course Completed
- Policies and Procedures Completed
Random Audit File
This audit should be performed based on your Random Selection names. Begin with the selection list, if any failures occur, work in brackets (Selection last name is Johnson, Bracket I and K for failure selections) in both directions until you have found complete files.
Has the employee been employed for more than one year?*
- Yes
- No
Please enter the date of hire*
MM slash DD slash YYYY
Does the employee have any items that have been renewed?*
- Yes
- No
Which items have renewed since Date of Employment.
- MVR (Motor Vehicle Record/Annual Certification of Violations)
- CDL (Commercial Driver License)
- MEC (Medical Examiners Certificate)
New expiration date of MVR*
MM slash DD slash YYYY
Was MVR renewed prior to the expiration of the last MVR?*
- Yes
- No
Is the Annual Certification of Violations signed and dated properly?*
- Yes
- No
Does the New MVR status match the MEC card on file?*
- Yes
- No
New expiration date of CDL*
MM slash DD slash YYYY
Is the new CDL consistent with the MVR on file?*
- Yes
- No
Is documentation present in file that indicates a Driver License Status Check has been done?*
- Yes
- No
New expiration date of MEC*
MM slash DD slash YYYY
Does the New MEC Status match the MVR on file?*
- Yes
- No
Is a new NRCME (National Registry of Certified Medical Examiners search results) present in file?*
- Yes
- No
Is the new doctor certified?*
- Yes
- No
Does the doctors name on the MEC card match the Search Results?*
- Yes
- No
Are both dates of issue and expiration listed on the MEC card?*
- Yes
- No
Is the Doctors phone number written on the card?*
- Yes
- No
Is this file ready to be finalized?
Does this file appear to be ready to go?
- Yes
- No
Please Explain needed action items.*
Good to Go
Good-to-Go-Please enter name of company recipient you would like to notify:*
First Last
Good-to-Go-Please enter email of company recipient you would like to notify:*
Enter Email Confirm Email
Not good to Go
Not Good-Please enter name of company recipient you would like to notify:*
First Last
Not Good-Please enter email of company recipient you would like to notify:*
Enter Email Confirm Email
Summary Audit Finding and Documentation
Is this file DOT compliant or Not?*
- This file is a DOT Compliant file
- This file is NOT a DOT compliant file
Please explain the summary issues/facts:
Were actions taken to make the file COMPLIANT?
- Yes
- No
Please explain the summary actions taken to make this file compliant:*
Do you believe there is any possibility that this file can be made compliant at this time?*
- Yes
- No
Please provide information or instructions on how to make this file compliant at this time:
Renewals File Audit
Both the Driver Qualification and Safety Performance History Files must be retained for as long as the safety-sensitive individual is employed by the company, and for three years thereafter. The following documentation may be discarded from the Driver Qualification File three years from the date of execution: Annual List of Violations, Annual Inquiry to Sate Agencies, Annual Review of Driving Record, Medical Examiner’s Certificate, Safety Performance Evaluation Certificate (if applicable)
Documents Present*
- CDL
- MEC
- MVR
MEC Renewals
MEC Recordkeeping*
- Currently Hawaii, Utah and Oregon do not report to MVR
The Federal Motor Carrier Safety Administration (FMCSA) officially published its highly anticipated final rule delaying “portions” of the regulation tying the Commercial driver’s license (CDL) to the holder’s medical qualifications. Driver recordkeeping Non-excepted, interstate CDL holders must continue to carry a copy of the medical examiner’s certificate while on duty until January 30, 2015. Non-excepted, interstate Commercial Learner’s Permit (CLP) holders must continue to carry a copy of the medical examiner’s certificate while on duty until July 8, 2015. Carrying the medical examiner’s certificate is required for both CDL and CLP holders even if they have self-certified and submitted the medical examiner’s certificate to the state licensing office and the information appears on their driving record (i.e., motor vehicle report (MVR)). If a driver’s state of licensing is currently collecting the self-certifications and medical certificates, all CDL/CLP drivers must continue to submit the required documentation to the state licensing office, including subsequent renewals of their medical certificates, or face a downgraded license. Motor carrier recordkeeping Motor carrier recordkeeping would be based on whether or not the state licensing office has entered the medical information onto the driver’s MVR. The employer must verify the medical certification status, and subsequently the CDL status, via the MVR if the report shows medical certification information. (The driver submitted it, and the state posted it.) This was the case under the previous verbiage as well. Similarly, if the state licensing office has collected the self-certification and medical examiner’s certificate for its CLP holders and the information appears on the driver’s MVR, the motor carrier is responsible for obtaining a copy of the MVR to verify the information. If the state of licensing has not collected the self-certification and medical certification on the CDL or CLP holders — or has not entered the information it has collected onto the driver’s record — the motor carrier may continue to use the medical examiner’s certificate in the DQ file as proof of qualification for non-excepted, interstate CDL or CLP drivers. Should the state implement the process through the course of the year (i.e., driver submitted it; state posted it to the MVR), the motor carrier would be responsible for requesting the MVR from the state of licensing to verify the driver’s medical and license status. No later than January 30, 2015, dependent upon the state’s implementation date, all motor carriers must have MVRs for all non-excepted, interstate CDL drivers showing the medical status. No later than July 8, 2015, dependent upon the state’s implementation date, all motor carriers must have MVRs for all non-excepted, interstate CLP drivers showing the medical status. Drivers and motor carriers will need to consult with their state licensing agencies to determine which deadlines apply.
MEC Template*
- Yes
- No
Is the Issue date listed on the document?
- Yes
- No
Is the Expiration date listed on the document?
- Yes
- No
Do the Expiration date and Issue date appear to be the same handwriting?
- Yes
- No
Do the Expiration date and Issue date appear to be consistent in time for the receipt of the MEC card?
- Yes
- No
Are there any waivers noted?
- Yes
- No
What are the waivers?*
- Corrective Lenses
- Diabetes
- Prosthetic Limb
- Other
Is this an Interstate or Intrastate Card?
- INTER State
- INTRA State
Doctor is registered on the National Registry of Certified Medical Examiners (NRCME) system?
- Yes
- No
CDL Renewals
CDL Template
- Yes
- No
MVR Renewals
MVR Template
- Yes
- No
How many MVRs are present in the renewals file?
- 1
- 2
- 3
- More than 3

Save and Continue Later

AUDIT

DOT Qualification File Audit

Application Information

CDL Information

MEC Information

MVR Information

COC Information

DTR Information

RT Information

CFR Information

Office of Drug & Alcohol Policy & Compliance 1200 New Jersey Ave, SE W62-300 Washington, DC 20590 United States ODAPCWebMail@dot.gov Phone: (202) 366-3784 Alt: (800) 225-3784 Fax: (202) 366-3897

NRCME Information

HOS Information

Certificate of Compliance Information

FMCSR Information

DAP Information

Personnel File

Payroll File

I9 Document

W4 Document

PAN Document (Personell Action Notification)

Health File

Training File

Random Audit File

Is this file ready to be finalized?

Good to Go

Not good to Go

Summary Audit Finding and Documentation

Renewals File Audit

MEC Renewals

CDL Renewals

MVR Renewals

Questions?