Fillable Printable School Bus Driver Health Certificate: SDE Annual Physical Form - Oklahoma
Fillable Printable School Bus Driver Health Certificate: SDE Annual Physical Form - Oklahoma
School Bus Driver Health Certificate: SDE Annual Physical Form - Oklahoma
This form may be duplicated. Revised 8/09
Oklahoma State Department of Education (SDE) - 2500 North Lincoln Boulevard - Oklahoma City, Oklahoma 73105-4599
Student Transportation Section (405) 521-3472
Oklahoma School Bus Driver Health Certificate: SDE Annual Physical Form
The Oklahoma State Board of Education requires each school bus driver to pass a physical examination. Oklahoma regulation
requires (1) an annual physical using this form; or (2) a physical every two years using a Department of Transportation (DOT) form.
Schools must keep completed health certificate forms on file for one year at the district for their Regional Accreditation Officer.
*A person taking insulin by injection does not meet Oklahoma SDE qualifications to drive a school bus.
**A school bus driver’s vision must be 20/40 or better; corrective lenses are acceptable.
County Name ______________________Employing School District _______________________________
School Bus Driver Name (PRINT)_______________________________________ Birth Date___________
1. Is this applicant Diabetic? No / Yes : Controlled by diet and/or oral medication only? Yes
*Is this applicant dependent on insulin by injection? No / Yes
2. **Vision (Snellen Test): Left Eye 20/_____ Right Eye 20/ _____ Using Both Eyes 20/ _____
Are Corrective Lenses required to drive? No / Yes Comments:________________________
3. Hearing Test Results: Acceptable / Not Acceptable Hearing Aid(s) Required Yes / No
Comments________________________________________________________________________
4. Deformities or missing limb? No / Yes Specify: ______________________________________
5. Seizures (past/present) No / Yes Specify: ___________________________________________
6. Paralysis (past/present) No / Yes Specify: ___________________________________________
7. Tuberculosis (past/present) No
/ Yes Specify:________________________________________
8. Alcohol addiction (past/present) No / Yes Specify:____________________________________
9. Drug addiction (past/present) No / Yes Specify:______________________________________
10. Heart disorder/disease (past/present) No / Yes Specify:________________________________
11. Normal Loco-motor: No / Yes Specify Limits:______________________________________
12. Arthritis: No / Yes Specify:______________________________________________________
13. Blood Pressure: _____ / _____ BP within normal limits? Yes / No Controlled by Rx?________
14. Emotional disorders (past/present): No / Yes Specify:_________________________________
15. List all prescription medications:
_____________________________________________________________________________________
“I certify that the above information I provided is correct and true to the best of my knowledge.”
Signature of Bus Driver Applicant:________________________________________ Date _________________
Oklahoma Licensed Physician (PRINT Name) M.D. / D.O. / D.C.
Address City Zip Phone
“Based on the history provided by applicant, and my medical examination on this date, the above applicant
IS / IS NOT physically and emotionally competent to drive a school bus to haul students.”
Signature of Physician: Date: Year:
