Annual Review of Driving Record Form for NEMT Drivers: Pull, Check, Decide, Sign

Pulling a driver’s record once a year is only half the job. The other half is proof that someone read it, compared it with your broker’s limits, and decided the driver could keep carrying riders. This form is that proof: one sheet per driver per year, filed next to the record in the driver qualification file.

How to use this template

1. Set the due date from the last review. The federal rule asks for a review at least once every 12 months, so count 12 months from the last one, not from January. Write both dates in Part 1.
2. Have the driver’s written consent on file before you order anything. Under the federal driver privacy law, a state may release the record to any requester who holds the driver’s signed consent, while the clause for employers names only commercial driver’s license holders (18 U.S.C. 2721(b)(9) and (b)(13)). If a screening company pulls the record, credit reporting law also calls for a stand-alone written notice and the driver’s signed permission, and a permission meant to cover every yearly pull must say so clearly (FTC guidance, October 2016). The motor vehicle record check page covers how to order one.
3. Ask the driver where they held a license during the period the record must cover, and pull a record from each of those states in Part 2.
4. List every entry in Part 3, including old ones and crashes with no ticket, with the date, the state, and whether your vehicle was involved.
5. Check the record in Part 4 against each rule you work under, in the words the broker or state uses. Then add what you know beyond the record: tickets the driver reported, crash reports in your files, and complaints.
6. Decide and sign in Parts 5 and 6. If the driver no longer qualifies, take them off trips that day and send the notices in Part 5.
7. Put the next due date on your calendar. NEMT recredentialing shows how the yearly record fits with the other renewals.

The template

Part 1: Driver and review dates

Field	Entry
Driver’s full name, as on the license
Date of birth
License number, state, and class
License expiration date
Endorsements and restrictions
Vehicles this driver drives (sedan, wheelchair van, stretcher van, van for 9 or more people)
Commercial motor vehicle under federal rules? (yes or no, and why)
Brokers and plans this driver’s trips go to
Date of the driver’s written consent to pull the record
Date of last review
This review is due by (12 months after the last)

Part 2: Records pulled

State or licensing authority	Record type ordered	Period covered (from, to)	Date ordered	Date received	Copy filed

Driver’s statement	Initials and date
I held a driver’s license or permit only in the states listed above during the period covered.
I have reported every ticket, crash, and license action since my last review.

Part 3: What the records show

Write “None” on the first line if the records show no entries.

Date	State	Entry (conviction, crash, suspension, points)	Convicted or at fault?	In a company vehicle?	Notes

Part 4: Limits checked

Rule	The limit, in its own words	Look-back period	Meets it?
Federal disqualifications, 49 CFR 391.15 (commercial motor vehicles only)
Broker contract:
Second broker or health plan:
State Medicaid or licensing rule:
Insurance carrier’s driver guidelines:
Company policy:

Other evidence considered	What it shows	Reviewed
Tickets and crashes the driver reported this year
Crash and incident reports in your files
Rider, facility, or broker complaints about driving
Violations found at roadside inspections (commercial motor vehicles)

Part 5: Decision

Decision	Check one	Details
Disqualifying offenses found (list each, or write None)
Qualified: meets every limit in Part 4
Qualified with action (coaching, a defensive driving course, a closer look at the next record)		Action and due date:
Not qualified: removed from driving		Date disqualified, date removed, and the reason:
Broker told, if removed (who and when)
State told, if a rule requires it (who and when)
Driver told of the decision		Date:
Screening company report used: copy of report and summary of rights sent before acting		Date:

Part 6: Reviewer’s note and sign-off

Sign-off	Name	Title	Signature	Date
Record reviewed by
Second reviewer, if the reviewer is the driver
Driver: I have seen this review

Next step	Date
Next review due by
Added to the recredentialing calendar

What the federal annual review requires

For drivers of commercial motor vehicles, 49 CFR 391.25 sets three yearly duties, as the eCFR shows it on September 30, 2026:

• The inquiry. At least once every 12 months, ask each licensing authority where the driver held a license or permit to drive a commercial motor vehicle during the period for the driver’s motor vehicle record, covering at least the preceding 12 months (391.25(a)).
• The review. At least once every 12 months, review the record to decide whether the driver meets the minimum requirements for safe driving or is disqualified under 391.15. You must consider the driver’s accident record and any evidence of traffic law or federal safety rule violations. Give great weight to violations such as speeding, reckless driving, and driving under the influence, because they show a disregard for public safety (391.25(b)).
• The note. Keep a copy of the record and a note with the reviewer’s name and the review date in the driver qualification file (391.25(c) and 391.51(b)(4) and (5)). Parts 2 and 6 of the form are that record and that note.

The disqualifications in 391.15 are the floor, not the whole review. A driver may not drive a commercial vehicle while the license is suspended, revoked, withdrawn, or denied, and must tell you about a suspension, revocation, or withdrawal notice before the end of the next business day. A conviction for an offense committed on duty disqualifies the driver for 1 year: driving a commercial vehicle under the influence of alcohol or certain drugs, refusing a required alcohol test, carrying, possessing, or unlawfully using those drugs, leaving the scene of an accident in a commercial vehicle, or a felony involving one. A conviction only for carrying or possessing the drugs disqualifies for 6 months, and a second disqualifying conviction within 3 years for 3 years. A conviction for violating an out-of-service order disqualifies too, and so do two convictions within 3 years for texting or using a hand-held phone while driving a commercial vehicle.

If your form still has a box for the driver’s own yearly list of violations, drop it. That rule, 49 CFR 391.27, is gone. FMCSA’s Record of Violations final rule, published March 9, 2022 and effective May 9, 2022, removed it as largely duplicative of the yearly record pull. The same rule changed the yearly inquiry from each state to each licensing authority where the driver held a license, so a license from outside the United States counts too.

If a driver needs a commercial driver’s license for the vehicle, add one more yearly check: a query of the FMCSA Drug and Alcohol Clearinghouse at least once a year (49 CFR 382.701(b)). See do NEMT drivers need a CDL for when a license is required.

Which NEMT drivers the federal rule covers

The federal rule reaches a commercial motor vehicle used in interstate commerce. That is a vehicle rated or weighing 10,001 pounds or more, or one designed or used to carry more than 8 people, driver included, for pay (49 CFR 390.5T). Interstate commerce includes a trip between two places in one state when it passes through another state or is part of a trip that starts or ends in another state. Most sedans and minivans in NEMT work fall outside the definition. A van rated 10,001 pounds or more, or one with 9 or more seats, falls inside it on trips that are part of interstate commerce.

The same rules list an exception for “the transportation of human corpses or sick and injured persons” (49 CFR 390.3T(f)(4)), and the definitions in 390.5T do not define the phrase. Ask FMCSA how it applies to your trips before you rely on it. Do NEMT companies need a USDOT number walks through the rest of the federal test.

Medicaid sets its own floor either way, whatever the vehicle. Section 1902(a)(87) of the Social Security Act requires each state to make sure, by the provider’s attestation if the state chooses, that every NEMT provider it pays has a process to disclose each driver’s driving history, traffic violations included, to the state Medicaid program (CMS, SMD 23-006, September 28, 2023). A dated, signed review for every driver is the record that process draws on.

Broker and state yearly rules

For drivers the federal rule does not reach, broker contracts and state rules set the yearly review. Each program sets its own look-back and its own limits, so Part 4 has a line for each. As of October 2026:

• MTM Health’s standard agreement (January 1, 2023, as Pennsylvania posts it) asks for records on each driver and attendant, owner-drivers included, with a motor vehicle driving record report for the previous 3 years, every year (section 5.C). It bars drivers convicted of 3 or more at-fault moving violations, or 2 or more at-fault accidents with injury or damage, in the previous 36 months. A driver is presumed at fault in an accident unless the driver shows otherwise, and police reports are required to prove a no-fault accident (5.J). A conviction includes a guilty plea or a plea of no contest (5.L). MTM pays nothing for trips by uncredentialed drivers (6.B).
• Transdev in Hawaii, which arranges AlohaCare’s rides, asks in its driver credentialing checklist (July 2024) for a motor vehicle report covering the past 5 years. A Hawaii district court driver abstract may stand in for it if it checks all federal vehicle records, not only county and state ones. The checklist’s standards include no moving violations in the past year, no drunk or impaired driving convictions, no refusals to test, no leaving the scene of an accident, no preventable major accidents in 3 years, and no more than two preventable accidents in 3 years.
• Minnesota special transportation (Minnesota Rules 8840.5900, subpart 13a) requires you to get each driver’s record every year, showing the driver is still not disqualified. Rule 8840.6100 asks for a statement signed by the reviewer with the date the records were checked, the driver’s full name and birthdate, any disqualifying offenses, whether the driver meets the standards, and the documents relied on. If the driver fails, the statement adds the date of the disqualification, the reason, and the date the state was told. The form’s Parts 1 to 6 cover each item.

Your insurance carrier may set its own limits too, so ask your agent for them in writing. The motor vehicle record check page compares the limits several brokers and states use.

When the review turns up a problem

1. Stop the driver’s trips the day you find it. Minnesota requires you to stop using a driver who no longer meets its standards right away (8840.5900, subpart 16), and MTM Health does not pay for trips by uncredentialed drivers.
2. Tell the people who must know. Minnesota requires a report to the state of the withdrawal and the reason. MTM Health’s agreement requires immediate notice of a driver’s conviction for an alcohol-related driving offense (section 2.R).
3. Settle fault with paper. For each crash in Part 3, file the police report. Under MTM Health’s agreement, a crash without one counts against the driver.
4. Follow credit reporting law when a screening company supplied the record. In its July 2011 staff report, the FTC says a driving record a screening company provides about a current employee is a consumer report, just as it is for a job applicant. Before you remove or reassign a driver based on one, give the driver a copy of the report and the summary of rights (FTC guidance, October 2016). The pre-adverse action notice covers that step.
5. Write down any action short of removal in Part 5, with a due date, and check that it was done at the next review.

The yearly review sits alongside the criminal background check that brokers such as MTM Health also require every year (section 5.C). See NEMT driver background checks for those.

How long to keep each review

Keep each sheet, with a copy of every record it lists, for the longest period any rule you work under requires:

• Federal driver qualification file: the whole time the driver works for you, plus 3 years. The yearly record and the review note may come out 3 years after they were made (49 CFR 391.51(c) and (d)).
• Minnesota special transportation: at least 3 years (8840.6100, subpart 10).
• MTM Health’s standard agreement: full records of your operations under the agreement for 10 years, or longer if law or MTM’s client requires it (section 2.S).

The NEMT record retention guide covers the rest of your files.