Penggunaan Borang Pemeriksaan Kesihatan (Jpjl8a) Baharu Bagi Permohonan Atau Pembahruan Lesen Vokasional - 20HB Ogos 2019

^:^ IBU PEJABAT I^;^
JABATAN PENGANGKUTAN JALAN MALAYSIA

.
I
ARAs 3-5, No. 26, JALAN TUN HUSSEiN
Telefon : 0388928000
I, w PERSIARAN PERDANA, PRESINT 4
," Telefax : 0388810293
PUSAT PENTADBIRAN KERAJAAN PERSEKUTUAN
unuw"fr
62100 PUTRAJAYA
Portal Rasmi : WWW. IPj. gov. my ^-*,.
^*04"akin"11P. ,*,/
",- -
MAU^Vs!ANl, ^:ALASSOCi^Î^
ER ^^; C ;a :: V 181 D Ruj, Kami : JPJ. BM. 700-4/1/31(16)
28 AUG 2019 Tarikh : '>"^> Ogos 2019
Seperti diedaran
Tin~,,,,^^.
lodged oak^
YBhg Dato'/ Tuan/
PENGGUNAAN BORANG PEMERiKSAAN KESIHATAN (JPJL8A) BAHARU BAGl

PERMOHONAN ATAU PEMBAHARUAN LESEN VOKASIONAL
Dengan hormatnya saya diarah merujuk kepada perkara diatas dan mesyuarat pada
19 Ogos 2019 antara JPJ, KKM dan MMA adalah berkaitan,
2. Seperti yang sedia makium, prosedur pemeriksaan kesihatan bagi

menentukan tahap kesihatan pemandu kenderaan perdagangan telah sedia ada
digunapakai bagi tujuan permohonan atau pembaharuan Lesen Vokasional
(PSV/GDL).
3. Penggunaan borong pemeriksaan kesihatan dibahagikan kepada dua kategori

iaitu semasa permohonan Lesen Vokasional (JPJL8A - LAMPIRAN A) atau semasa
pembaharuan Lesen Vokasional (JPJL8 - .LAMPIRAN B), Dalgm hubungan ini,
Jabatan ini me Iihat terdapat keperluan untuk menambahbaikan penilaian
pemeriksaan kesihatan meIaiui penggunaan borong pemeriksaan yang sedia ada.
4. Bagi tujuan tersebut, satu jawatankuasa penilaian semula telah ditubuhkan

yang terdiri daripada Kernenterian Pengangkutan Malaysia (MOT), Jabatan
Pengangkutan Jalan (JPJ), Kernenterian Kesihatan Malaysia (KKM), Agensi
Rengangkutan Awam Darat (APAD) dan Jabatan Kebajikan Masyarakat (JKM).
MeIaiui jawatankuasa inI, pemeriksaan kesihatan telah dikaji semula dengan format
baharu borang pemeriksaan kesihatan yang Iebih komprehansif dan praktikal. Selari
dengan itu, penilaian ini juga telah mengambil kira 9010ngan Orang Kelainan Up aya
(OKU) bagi memberI peluang kepada golongan ini untuk mengendalikan Kenderaan
Perkhidmatan Awam (PSV - teksi/kereta sewa/e-hailing) sahaja.
5. Hasil penilaian tersebut telah meinutuskan bahawa permohonan baharu atau

pembaharuan Lesen Vokasional hendaklah menggunakan format baharu borang
pemeriksaan kesihatan (JPJL8A - LAMPIRAN C). Elemen pemeriksaan boleh
dirujuk meIaiui Standard Pemeriksaan Perubatan bagi Lesen Vokasional (Mediba/
Examination Standard - LAMPIRAN D).
6. Mesyuarat penyelarasan yang melibatkan JPJ, KKM dan Malaysian Meatoa/

Association (MMA) berhubung penggunaan borong pemeriksaan kesihatan (JPJL8A)
baharu bagi permohonan at au pembaharuan Lesen Vokasional yang diadakan pada
19 Ogos 2049 di Ibu Pelabat JPJ telah meinutuskan perkara seperti berikut :-
6.4. Penggunaan borang pemeriksaan kesihatan baharu (JPJL8A
LAMPIRAN C) adalah terpakai bagi permohonan atau pembaharuan
Lesen Vokasional;
6.2. Penggunaan borong borang pemeriksaan kesihatan baharu (JPJL8A -

LAMPIRAN C) akan inula berkuatkuasa pada I Oktober 2019;
6.3. Sebagai tempoh peralihan borang (JPJL8A - LAMPIRAN A) dan
borang (JPJL8 - LAMPIRAN B) yang telah mendapat pengesahan
pegawai perubatan kerajaan/ pengamal perubatan yang berdaftar
sehingga tarikh 30 September 2019 bo!eh diterima sebagai dokumen
rasmi untuk urusan permohonan/ pembaharuan Lesen Vokasional
sehingga I5 Oktober 2019;
6.4. Bayaran pemeriksaan kesihatan yang dikenakan bagi setiap

pemeriksaan (JPJL8A) untuk seorang di klinik swasta beadaftar
(general practitioner) ditetapkan sebanyak RM80.00. Kadar bayaran ini
tortakluk kepada pindaan semasa yang dipersetujui bersama kelak;
6.5. Bayaran pemeriKsaan kesihatan di fasiliti kesihatan kerajaan adalah
tertakluk kepada perlntah fi (perubatan) yang dikeluarkan o1eh KKM.
6.6. Pihak JPJ dan KKM hendaklah me inbuat hebahan be inubung

penggunaan borang pemeriksaan kesihatan (JPJL8A) yang baharu ini
ke daiam portal rasmi dan kepada pihak yang berKaitan dibawah
seliaan agensi masing-masing;
6.7. Pihak MMA hendaklah meinbUat pemakluman dan hebahan kepada

semua pengamal perubatan yang bertauliah dan klinik swasta yang
beadaftar berhubung garis panduan, kadar bayaran dan proses
pemeriksaan yang perlu dibuat me Ialui penggunaan borang
pemeriksaan kesihatan baharu (JPJL8A - LAMPIRAN C).
7. Segala kernusykilan mengenai peKara jin hendaklah dirujuk kepada Bahagian

Pelesenan Pemandu, tou Pejabat Putrajaya. Perhatian dan keriasama berhubung
perkara ini am at Iah dihargai.
Sekian, terima kasih.
"BERKHIDMAT UNTUK NEGARA"

"MESRA, CEKAP, TELUS"
Saya yan en nkan am ariah,
(RIZAL Z I MAT RAWl)

Pengarah Pelesenan Pemandu
b. p. Ketua Pengarah Pengangkutan Jalan
Malaysia.
SENARAI EDARAN.
Kernenterian Kesihatan Malaysia (KKM)

Sektor Kesihatan Pekerjaan dan A1am Sekitar,
Bahagian Kawalan PenyaKit,
Kernenterian Kesihatan Malaysia,
Aras 2, BIOk E3, Komp!ek E,
Pelabat Kerajaan Persekutuan Persint I,
62590 Putrajaya.
(ulp: DR. PRIYA RAGUNATH)
Setiausaha Agong
I~., -
.,
Malaysian Medical Association (MMA)
,... I ... .
.., . Tingkat 4, Bagunan MMA,
, . ,. . I
V. ~- ' ~ 124, Jalan Pahang,

53000 Kuala Lumpur.
(ulp: DR. THIRUNAVUKARASU RAJOO)
s. k:
YBhg. Dato' Sri Shaharuddin Khalid

Ketua Pengarah Pengangkutan Jalan Malaysia
YBrs. Tuan Zamakhshari Bin Hanipah

Timbalan Ketua. Rengarah (Perancangan dan Operasi)
Tuan Shamsudin Bin Sharif

Pengarah Bahagian Teknologi Digital
Puan Zahidah Binti Abd Jalil

Bahagian Korporat Dan Perancangan Strutsgik
Bahagian Logistik Dan Pengangkutan Daret

(En. Mohd Kamal Hisham Abu Bakar)
Bahagian Perancangan StrategiK dan Antarabangsa

(Pn. Nur Ayuni Mahammad Zin)
LAM PI RAN A
,
,
^,:;
\ ,.,.
J PJ L8A
-^;,.--. I
\*^,,,, 21
PERMOHONAN LESEN VOKASIONAL
(1) Sila baca panduan di inuka belakang sebelum mengisi borang ini
(ill Gunakan HURUF BESAR
11ii) TandakanIdalam petak berkenaan
A. JENIS PERMOHONAN 1<ELAS LESEN DIPOHO
B. BUTIR-BUTIR PEMOHON
L. No. KP I Pasport I ategori

Polis I Tentera
3. Nama
4. A1amat
5. POSkod 6; andar
7. Negeri
8. Ja, tjna Ulp)

'. mm mm 11n r.
C. BUTIR-BUTIR LESEN
,. Tarikh Luput 3, No. Lesen

Lesen Meinandu
2. Ruangan ini Untuk Permoh n Baru at au Penambahan Kelas Lesen Vokasional Sahaja
Tarikh Luput Lesen No. Lencana
Vokasionat(inka ada) (jika adaj
Kelas Lesen Kod Kegunaan

Vokasional I^ (Untuk kegunaan pejabat
D. PENGAKUAN
Saya mengaku bahawa semua in aklumat yang dibenarkan adalah benar.

Ta rikh .,....,..... ....., ......... ......... ......... ...... ..........,........ .,, .......... ..... .. ..., .,.., .. .. ... ..........
(tandatangan Pemohon)
Nama : .,......,.........................,,.........,.......,.,........
No. KIP ' ............,.........,.....,...,........,..,...................
E. MAI<LUMAT PEGAWAI PERUBATAN YANG BIASA MERAWAT :

(Sebutkan nama dan alamat Pegawai Perubatan yang biasa me rawat anda)
N a in a Pegawa i Peru ba ta n : ......... ........................ ......... ......... ..........,..........,,.,,,..,............ ...........,...,.....,.. ............ .,.......... .......,........
A1 a in at : ........, ...,.. ...............,........ .,. ......,,,............ ..........,. ...... ..,......... ............ .,,...............,.. ..,......... ....,......, .........,,. ............ ,........,....
...,.. ....,.......... ......... ......... ......,.. ............ ... ........................... ... ...,..... ...............,..,,..,,............ ......,.. ,.........,, .., ... ......,................
.
SALiNAN AsAL HENDAKLAH DIKEMUKAKAN 1<EPADA PENGARAH JABATAN PENGANGKUTAN JALAN.
I
F. PEMERIKSAAN PERUBATAN
(UNTUK DIPENUHI OLEH PENGAMAL PERUBATANj

BAHAGIAN I
N o. Pend a fta re n p emohon dl kilnik : ......,......,..............,.,...............,. Ta in<h pe n d a fta re n : ... ... ............... ... .. .... ...,...
Keadaan Uinuin : ........................,-----------......"""""""""""""""""""
Beret ' ,,',,,,, ' " ' "' '.- --..,. ...... .,.,,, Keri n g gi a n ,. . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , , . , . . . , . , . , . .. sin
Pemeriksaan air kencing untuk albumin dan gula 111ka POSitif SIasat selanjutnya).
JAWAPAN
Sita handakan X dalam ruang Yang bersesuaian 'Ya' at au 'Tidak'

Bit Perlhal Y Tidak Catitan
I Ada kecacatan dalam penglihatan warna ICarta 1stiha )
2 Ada kecacatan daiam penglihatan lapangan tileld onI
3 Ada bukti kecacatan sistem saraf
4 Ada bukti-bukti penyakit psikiatrik (psychi rt)
5 Adakah pemohonan menunjukkan tanda- Inu ak dan
penyalahgunaan dadah
6 Ada ketidaksempumaan dan I acata Ikaj
7 Ada butti kelainan 51stem kar S
8 Adakah pemohon me inpu ito n da tinggi Yang tidak

terkawal
9 Adakah pemoho engi e kit encing manis yang tidak
Terkawal denga in puma
10 Ada kecacatan pen gara
3.1 Ada bukti kelainan si piratori
1.2 Siasatan Ianjut yang on a an kan dan keputusannya :
a. .....,..........,...,.........,..,..................................,......,......,.,...,............,....................,...,.........................
b. .......,.... ..,......... ...............,................. ............,.. .,....... ..,..,......... ......,........ ................................. ........
. .......,.,.. .,. ............ ....,........., ...............,.. ............ .,..,.,..... .........,..... ....,. ......,..... ............,,.... .,,.., ... .., ....,.
1.3 Pandangan-pandangan lain o1eh pengamal perubatan :

...,.. ....,....,,. .,. ... ,...., ...... ........, .............................. ......,,.,,. ...................,...........,. ............ .,. ... ........................... ...... ...... ..,,,.,
........,....,..,. ..,......... ......,.,...,..,..,.............. ............ ... ...,..... ...........,........, ,..,....................,,,... .., ...... .................., ......,. .,. .,,.,.,
Cacatan : Kelewatan boleh berlaku kerana. diperlukan siasatan perubatan Ianjut.
BAHAGIAN 11
Silajawab soalan-5081an balkut berhubung dengan seiarah kesihatan anda. Tandakan X daiam kotak ruangan yang sesual 'Ya' atau
'Tidak'Jika 'Ya'jelaskan dalam ruangan catitan.
Adakah anda me in punyai seiarah at au sedang mengalami penyakit be in<ut :
Bil Perihal Ya ridak Catitan
*I Masalah mata
- katarak
~ Pandangan 'monocular'
- Lain-!ain yang menyebabkan halangan pandangan
*Z, Tidak dapat mengenalpasti warna-warna asas (primer) (merah, hijau,
Kuning (amber))
3 Sukar meIihat daiam gelap
2
*4 Apa-apajenis sawan at au kekejangan
5 Kecederaan be rat di kepala
*6 Serangan perilng at au perilng
7 Sakit kepala Yang be rat at au 'inigrane'
8 Pembedahan otak Yang 'major'
*9 Stroke' Idengan kecacatan 'residual')
*,. O Kencing manis dan rawatan insulin
*1.1 Penyakit mental
*1.2 Penyalahgunaan arak daiam masa 5 tahun Yang Ialu
*1.3 Penyalahgunaan dadah dalam masa 5 tahun yang Ialu
14 Kecacatan tulang belakang
*,. S Ketidaksempurnaan at au kecacatan anggota
- pergerakan sendi yang terhad
- kecacatan anggota Yang be rat
- 'amputation' Yang be rat
1.6 Penyakitjantung/ tekanan darah tinggi/ debaranjantung
1.7 Sesak nafas/'in untah darehI batuk kronik
*,. 8 Pekak
- Pekak tuli
*3.9 Penyakit buah pinggang yang kronik
20 Apa~apa rawatan yang berulang
21 Apa" apa penyakit at au kecederaan yang tidak dinyatakan di at as,
Saya dengan ini mengisytiharkan bahawa saya dengan teliti mengambil kir ke taan dibuat di at as dan saya percaya ianya
Iengkap dan tepat. Saya seterusnya mengisytiharkan bahawa saya tidak me n Ika pa-apa makiumat atau me inbuat apa-
Ta rida ta n ga n p emohon :... ..,... ... .....,...... ... ...,,....... ,..,... mm

N a in a ( d a I a in h u ruf besa r) : ......,,,......... ...... ... ...... . ,... ...... .......
Disa ksika n o1e h : ( Do. .. ...... -- -,.,...... "' "' ' ' ' ' ' ' ' ' ' "' "' " ' ' ' ' ' " ' ' ' Tein pat dip eriksa :,..,,,..,............ .............,,...,........,.....,.. .,. ......
Co n a in a d a n 'awa ta n :... ............ ............ ............ .. ... Ta ri k h : ... . . . ... . . . . . . ,.. . ., . .. . . . . .. .. . . .. . .. , . M a s a ; .. . .. . ... ... .. . . .. .,, . . . . . . ... . ..
it AYAKITIDAl< LAYAK SEMENTARAITIDAK LAVAK

Definisitidak lavak sementara : apa-apa keadaan perubatan 'reversible' untuk me mandu dengan selamat chialan raya, kenderaan
bermotor of daiam kelas at au kelas-ketasnya untuk Yang mana dia telah memohon lesen me mandu at au me in perbaharui lesen
me mandu.
Ta n d a to riga n pe riga in 81 p e ru bata n :......... ... .....,...... ... .,,.................. ...... ..,.... .
N a in a d a n kelaya ka n p e rigain a I p e ru bata n :....,. .,.... ...,,. ... ............... ... ......... No. Pe n d afta ra n M M C :......,..,....,..,..................... .....,,..... .... .
A1 a in a t : . ., ... .. . ., . .,. .,. . . . ,. . . ., .. .,. . ... . .. .. . . .. . .. . ., ., . .. . . . . .,, . . . ... ,. . ,,, ... . . . . . . .. . . . . . . . . . . .. . ... .,. . .. . . N O P e n d a ft a ra n Kl i n ik : ,,. . . . ,.. .., . .. .. . .,, . . . ... . . . . .. ..,. ., .,, .. . ... .. . . . . .,.,
...................,........,...................,.................,......................................,............,.,.,.,.............,..,...,..........................................,.,......,.....................,.....
Ta rikh :,.,......... ..........,,...,..,......... B aya ra n Ya rig Dike n a ka n :....,.......,.,...... ......... .,,....,....,. N O Rest t:,,.,...................,..,............... .......,. ...... ...
3
PANDUAN MENGisi BORANG PERMOHONAN LESEN Voi<AsioNAL UpJ L8A)
PERHATIAN:
co Borang iniperlu diisiapabila:
a, Anda memohon lesen vokasioanal baru.
b. Anda mein perbaharui lesen vokasional.
c. Anda menambah kelaslesenvokasional,
d. Anda memohon salinan lesen vokasional.
Iii) Gunakan SATU boreng untuk SATU jenis transaksi sahaja.
inn Tulis dengan terang danjelas, gunakan HURUF BESAR.
Iiv) Dipetak yang disediakan, gunakan satu petak bagisetiap huruf at au angka dan tinggalkan satu petak kosongdi ant a perkataan. Gunakan
ejaan ringkasjika ruangan tidak mencukupi.
BAHAGIAN A. JENIS PERMOHONAN KELAS LESEN DIPOHON
Gunakan kod berlRut dan pillh satu sahaja. D , E , Ei. , E2

KENDERAAN PERKHIDMATAN AWAM KENDERAAN BARANGAN
02 LESEN BARU 01 LESEN BARU
1.2 BAHARUI LESEN . 11 DAHARUI LESEN
22 TAMBAH LESEN 21 TAMBAH KELAS LESEN
32 SAUNAN LESEN 31 SALINAN LESEN
52 BAHARUI DAN TAMBAH KELAS 51 BAHARUI DAN TAMBAH KELPs
LESEN LESEN
62 BAHARUI DAN SALINAN LESEN 61 BAHARUI DAN SALINAN LESEN
66 TAMBAH KELAS DAN SALINAN 65 TAMBAH KELAS DAN AN
LESEN LESEN
69 BAHARUI DAN TAMBAH KELAS 68 BAHARUIDAI BA ELF
DAN SALINAN LESEN DAN SALl EN
BAHAGIAN B. BUTIR-BUTIR PEMOHON
I. No. KP/ Pasport/ Polis/Tentera
2. Kategori Pemohon
- OrangAwam Malaysia 7 - Sill Kelahiran Malaysia

' 2 - Anggota Polis 8 - Rest! Pengenalan sementara
9 - Lain-lain
3. Nama Penuh -15ikan nama anda sepertidalam kad pengenalan atau pasport.
4. A1amat - 151kan 31amat rumah anda sekarang sekiranya berlainan dengan alamat of lesen.
5. POSkod - ISIkan POSkod kawasan anda menelap sekarang.
6. Bendar - 151kan bandar tempat anda menetap sekarang.
7. Negeri - 151kan negeri anda menetap sekarang.
8. Jantina - ISIkan L- Lelaki P - Perempuan
9. Tankh tohir - 151kan tankh Iahir anda yang sebenar.
BAHAGIAN C. BUTIR-BUTIR LESEN
I. Tankh Luput Lesen Meinandu Jika tarikh Iuput lesen me mandu ialah 30 Mac 1997, isikan :
3 o o 3 I .9 9 7
2. Untuk Penambahan Kelas Lesen Vokasional Jika tarikh Iuput Lesen Vokasional Ialah 30 Mac 1997, isikan:
Sahaja.
3 o o 3 I 9 9 7
Tankh Luputlesen Vokasional
NO Lencana 151kan nombor Lencana anda.
Ke!as Lesen vokasional 1st kan kelas lesen vokasional anda. Jika D dan E2, isikan: D E2
3, NO Lesen No. sin Lesen anda

I 2 3 4 5 6
BAHAGIAN E. MAKLUMAT PEGAWAI PERU8ATAN YANG BIASA MERAWAT:

Sebutkan nama dan alamat Pegawai Perubatan Yang biasa me rawat anda.
BAHAGIAN F. PEMERIKSAAN PERUBATAN

Bahagian inI hendaklah dini o1eh Pegawai Perubatan.
4
LAM PI RAN B
I:',
JABATAN PENGANGKUTAN JALAN MALAYSIA (JPJL8)
- -, ;\-^ PERMOHONAN LESEN VOKASIONAL
. ~~,.
i) SIIa baca panduan di inuka sebelah sebelum mengisi borang in I

ii) Gunakan HURUF BESAR
jjj) * Tandakan ,3'1dalam petak berkenaan
A. JENIS PERMOHONAN
.
B. BunR-BUTiR PEMOHON
I. No. KP I Pasport I Polls I Tentera 2, ori

.
3. Nama
4. A1amal
5. POSkod I^. 6. Bandar
7. Negeri
8. Jantina (L I P) . ankh L
Hari Bulan Tahun
C. BUTIR-BUTIR LESEN
I. Tankh Luput
Lesen Meinandu Han un
2. Ruangan in I Untuk Permohonan B u at nam an Kelas Lesen Vokasional Sahaja
Tarikh Luput Lesen No. Lencana 01ka ada)

Vokasional Oika ada) ri n Tahun
Kelas Lesen Kod Kegunaan

VCkasional (Untok kegunaan pelabat)
D. PENGAKUAN
Saya mengaku bahawa segala makiumat yang diberikan di alas adalah benar.
Tankh ......,.,......,.,.......,,...,,.........
.........,...,.....................................
Tandatangan Pemohon
E. * AKUAN DoKTOR
(Untok Permohonan Baru at au Pembaharuan Lesen Vokasional Sahaja)
Saya sahkan pada h ari ini tela h me in eriksa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . , , . . . . . . . . . . . . . . . . , . , . . . . . , . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No. K. P. , . .. ... . . ... .. ... .. .. ... . . . . ... . .. ... . . . . . . . . .. . ..... d an pada pendapat saya beliau " sesuai I tidek ses uai untok
. Meinandu Kenderaan Perkhidma!an Awam
. Meinandu Kenderaan Barengan
. Be keria Sebagai Konduklor Bagi Kenderaan Perkhidmalan Awam
Ta ridalangan Doktor . , . . . . . . . . . . . . . . . . . . . . . . . . . .,. . . . . . . . . . ..

Tankh .......,...........,,,.................,.
Nama ...,,,.,....,................,...,........
,* potong yang mana lidak bentenaan A1amal KlinildHospilal. ... .. ....... .,. ,. .,. . . .,. .,... ...,.. . ... .
KEGUNAAN PEJABAT
(JPJL8)
(BORANG INTERNET)
PANDUAN MENGISI BORANG PERMOHONAN LESEN VOKASIONAL
PERHATIAN:
(1) Borang ini perlu diisi apab:Ia:-

a. Anda memohon lesen vokasional baru.
b. Anda meinbaharui lesen vokasional.
c. Anda menambah kelas lesen vokasional.
d. Anda memohon saunan lesen vokasional.
(ii) Gunakan SATU borang unluk SATUIenis transaksl sahela.
(iii) Tul;s dengan Ierang danjelas, gunakan HURUF BESAR.
(Iv) Dipelak yang dlsediakan, gunakan satu petak bagisetiap huruf amu angka dan tinggalkan satu petak kosong di enters perkataan.
Gunakan ejaan ringkas 11ka ruangan lidak mencukupi.
BAHAGIAN A. JENIS PERMOHONAN Gunakan kod balkut (Pith salu sahaja)

KENDERAAN PERKHIDMATAN AWAM KENDERAAN BARANGAN KONDUKTOR
02 - LESEN BARU 01 - LESEN BARU 03 - LESEN BARU
12 - BAHARUI LESEN 11 - BAHARUILESEN 13 - BAHARUILESEN
22 - TAMBAH KELAS LESEN 21 '- TAMBAH KELAS LESEN 33 - SALINAN LESEN
32 - SALINAN LESEN 31 - SALINAN LESEN 63 . BAHARUI DAN SALINAN
52 - BAHARUI DAN TAMBAHKELAS LESEN 51 - BAHARUI DAN TAMBAH KELAS LESEN LESEN
62 - BAHARUI DAN SALINAN LESEN 61 - BAHARUI DAN SALINAN LESEN
66 - TAMBAH KELAS DANSALINAN LESEN 65 - TAMBAH KELAS DAN SALINAN LESEN
69 - BAHARUI DAN TAMBAH KELAS DAN 68 - BAHARUI DAN TAMBAH KELAS DAN SALIN
SALINAN LESEN LESEN
BAHAGIAN B. BunR-BUTIR PEMEGANG LESEN
I. NO KP I Pasport I Polls I Tentera
2. Kalegori Pemohon
3. Nama ISIkan na a anda sep I a ad pengenal

4. Namat 151kan 81a urnah anda are rig.
5. POSkod I ' an POSko asa da menelap sekarang.
6. Bandar dar te da mendap sekarang.
7. Negeri is n n da enelap sekarang
8. Janlina ISIk elak , - Parempuan,
9. Tankh Lahir 15iKa rlkh Iahir anda yang Bebenar.
BAHAGiAN c. BunR-BUTIR LESEN
I. Tarikh Luput Lesen Meinandu Jika tankhluputlesen memandulalah 3011b Mejig91,1stkan :
3 o05,991
2. Unluk Penambahan Kelas Lesen Vok ' nal
Talkh Luput Lesen Vokasional Jika tankh Iuput lesen vokasionalialah 22hb Februari 1991,1st kan :
2 202,994
No. Lencana ISIkan nomborlencana anda.
Ke!as Lesen Vokaslonal Isikan kelas lesen vokasional anda. Jika D dan E2, ISIkan :
D E 2
BAHAGIAN D. PENGAKUAN
151kan Iarlkh dan landatangan pemohon.

BAHAGiAN E. AKUAN DoKTOR
Ruanganiniperlu diisloleh dokto:sahaja Tendakan ^;' dalam petak mengikutjenis permohonan.

LAM Pi. RAN C
.^.$1
,.'^til ,
*, a, ,,,
PEMERll<SAAN 1<ESIHATAN
PERMOHONAN LESEN voi<AsioNAL
J PJ L8A
co Sita baca panduan di inul<a surat tujuh (7) sebelum mengisi borang ini
un Gunakan HURUF BESAR A. IENIS PERMOHONAN:
(11i) Pemohon Orang 1<urang Up aya (OKU) hanya laval< memohon hase" PSV TYPE OFAPPLICATION:
(Tel<si/ Kereta Sewa/ Tel<SI Mewah/ E-Hailing) sahaja I^
(iv) Hanya pengesahan (Bahagian I at au J) perlu dil<emul<akan kepada
Jabatan Pengangkutan Jalan (JPJ) KELAS LESEN DIPOHON:
(v) Pemohon Yang menerima pengesahan "Tidalc layol{ untuk memohon
LICENSE CLASS APPLIED:
lesen memondu vokosionol untuk sementoro" pada Bahagian I
hendaklah me inbuat pemeri!<saan Icesihatan semula bagi mendapatl<an I^
pengesahan di Bahagian J
tvi) Bayaran pemeriksaan Itesihatan yang dibenarl<an bagi setiap
pemeriksaan untuk seorang ialah RM80.00
B. BUTIR-BUTIR PEMOHON
APPLICANT'51NFORMATION
I. Nama Pemohon:
Applicont's Name:
2. No. Kad Pengenalan: 3. Tarikh LahiT:
NRIC No. : Date of Birth:
4. A1amat:
Address:
5. Jantina: relaki/ Mole 6. No. Telefon :

Sex:
Nota:
. Perempuan/ Female Telephone No. :
Jika sedang mendapat rawatan untok sebarang masalah kesihatan, sila lampirkan sureylaporan danpada doktor yang me rawat
Note: If on treatment for ony meatc@Iconditions, pieo$e ottoch medicolreportfrom the ortending doctor
C, BUTIR-BUTIR LESEN
LICENSEINFORMATION
I. Tarikh Luput Lesen Meinandu: 2. No. Siri Lesen:

Exp^ry Dote of Driver's License: License Serial No. :
3. Tarikh Luput Lesen Vokasional (Iika ada): 4. No. Sin Lesen Vokasional:
Expiry Dote of Vocational Driver's Litense: Vocationalticense Serial No. :
5. Kod Kegunaan (untuk kegunaan pejabat):
Usage Code 170r office use):
D. PENGAl<UAN PEMOHON
DECLARATION BYTHEAPPLICANT
Saya mengaku bahawa semua in aklumat Yang diberikan di at as adalah benar.

I hereby declare that I have considered the above informotion ond bel^^ve it to be complete and true,
Tandatangan pemohon: No. Kad Pengenalan Pemohon:

Appffcont's Signature: Appl^Cant's NRIC No. :
Nama Pemohon: Tarikh:

Appffcant's Nome: Dote:
1/9
E. SEJARAH 1<ESIHATAN (Pemohon dikehendal<i menjawab semua soalan. Sila tandakan IX) pada ruang berkenaan)
MEDICAL HISTORY (Applicant must answer o11 questions. Please mark IXj in the relev@nt boxes)
Ya/ Tidak/ Ya/ Tidak/

Yes No Yes No
^. .. Adakah anda me in punyai masalah Adakah anda me in punyai masalah:

penglihatan/ sebarang penyakit mata/ Are you suffering from, '
pernah menialani pembedahan mata?
Do you frove ony problems with your
7, I. I. ,^ny^kitjan*my?
Heort Disease?
vision/@ny eye dise@ses/h@d ony surgery
to the eyes?
" I^ I^ Darah tinggi IHipertensij?
^gh BloodPressure (Hypertension)?
2.
^ I^ Adakah anda me in punyai masatah 8. ' ^ I. S^,înfo^?
pendengaran/ pernah mengalami penyakit Shortness ofbreoth?
atau kecederaan pada telinga?
Do you hove ony he onrig problems/hove
" I::. I^ Batuk berdarah/ batuk Yang
be maniangan linelebihiiO hari)?
you ever hod ony diseases or injuries to Cough with bloodin sputum/prolonged
your eors? cough hote thon Jodoys)?
Pernahkah anda menghidapi: 1-0- I^:I ILLI Penvakit kencing manjs?
Hove you ever had: 010betes Mellitus?
3,
^ I^ Sawan dan kelumpuhan? ''" I^ I^ Adakahandamengambilrawatan untuk
Fits/ Epilepsy or Paralysis ? sebarangmasalahkeslhatan?511anyatakan
Are you toking treatment for ony medicol

conditions?PIs s eci :
4.
I^ I^ Masalah sakit kepala, pening, pitam atau 1.2.
.. Adakahandamengalamikemalangan
pengsan untuk tempoh 6 bulan yang Ialu? untuk tempoh Itahun Yang Ialu?
Heodoches, dizziness, block-out onomting Hove you beeninvolvedin any occidents
spells in the past 6 months? over the post I year?
5.
I^ I^ Adakah anda me in punyai 1.3.
.. Adakah anda pemah menyalahgunakan
ketidaksempurnaan/ kecacatan fizikal, dadah, altohol at au ubat"ubatan?
mengalami sakit tulang dan sendi at au H@ve you ever misused drugs, o1coholor
pergerakan terhad pada mana-mana medcotion?
sendi?
Do you hove ony physicol@briormolities/
physicoldisobilities, musculoskeletol
disorders orlimitot, bn of movements of the
joints?
6.
I^ I^ PemahkahandamenghidappenYakit/ 1.4
1.1. Adakahandamengalamigangguantidur?
kecelaruan mental? Do you hove sleep disturbances?
Have you ever bud any meritolillnesses
ipsychiotricoisorders)?
F. PENGAKUAN PEMOHON (dengan disal<sikan Dieh Pengamal Perubatan yang memeril<sal

DECLARAnON BY THEAPPLICANT(witnessed by the exomining doctor)
IN. in. pm". "mats=I
Saya dengan inI mengisytiharkan bahawa saya telah dengan tellti mengambilkira kenyataan yang
dibuat di at as dan saya percaya ianya Iengkap dan tepat. Saya seterusnya mengisytiharkan bahawa saya tidak menyembunyikan apa-apa
in aklumat atau meinbuat apa-apa kenyataan palsu. Saya memberI 12in kepada pengamat perubatan Yang memeriksa untok berkomunikasi
dengan mana-mana pengamal perubatan yang memeriksa saya dan Jabatan PengangkutanIalan; daiam hal-halvang boleh memberikan kesan
ke at askesesuaian qntuk me mandu dalam perkara-perkara berkaitan dengan permohonan saya untuk lesen vqkasional. Saya bersetuju densan
keputusan pemeriksaan kesihatan Yang doralanka'n.
IAPplie. fit, full flamej
hereby dedore that I hove considered the obove informorion ond be"eve it to be complete ond
true. I o1so declore th@tldid not conceol@nyinformation nor give anyfolse statements. JPermit the exomining doctor to communicate with any
medicolpractitioner treoting me OS well OS with the Road Tronsport Deportment; in matters thot could affect the suit@billty to drive in issues
related to my application for o vocational license. Iwillobide by thenridings ond the results of this meditolexominotion.
Tandatangan pemohon: No. Kad Pengena!an Pemohon:

Appl^^grit's Signature: App"cant's NRICNo. :
Nama Pemohon: Ta nith :

Appl^ânt's Name: Date:
Nota: SIIa rujuk Medical Examination Standard for Vocational Driver's Licensing meIalui carian atas talian
Note: Please rater to Medical Examination Stondardjor Vocational Driver^ Litensing through online search
2/9
G. PEMERll<SAAN PERUBATAN (untul< ditengkapl<an o1eh pengamal perubatan Yang memeril<sa pemohon)
MEDICAL EXAMINATION (to be completed by the medicolproctit, brief)
I. Be rat badan: kg 2, Tinggi: cm 3. BMl : kg/in 4. Tankh pemeriksaan dualankan;
Weight: Height: BMl: Dote of ex@minorion:
5. Tekanan darah Blood pressure: 6. Kadar nadi: seminit 7. Linton Ieher:
51sto11k/ Systohc: mmHg Pulse rate: per Neck Circumference:
Diastollk/ Diastolic: mmHg minute
Seksyen L: Fenglihatan Arahan: SIIa tandakan IX) pada ruang berkenaan

Section Z: Vision
instructlon: Please mark (Kiin the relevant boxes
9. Tahap penglihatan roengan kacamata/ kanta sentuh sekiranya mein akal

Meinpunyai masalah penglihatan seperti berikut; kacamata/ kanta sentuh) berdasarkan carta Snellen is am aada carta nombor,
Hoving vision problems OS mentioned below: abjad areu carta E padajarak 6 meter)
Visuol ACUity (with glosses I contoct lenses fy' weofffig them) Dosed on
Snellen's Ch@rt (whether numeric0, o1phobeticol or E chort at o distonce of 6
metres).
Ya/ Tidak/ Tanpa dibetulkan/ Dibetulkan/
yes No Unaided Aided
^.. Nampak dua jinej Mata kanan
Double vision Righ t eye
^b . . Rabun warna Mata kiri
Colour bffndness
Left eye
^.. I. Rabun malam
Night blindness
Normal Abnormal
^ ^=I Medan penglihaEan (UjianKonfrontasi)
visualfield (Confrontotion Test)
ô I. L. Diplopia
Diplopio
it ^ I. Rebunwarna (UjianWarna ishihara)
Colour blindness fishingra Colour Test)
Nota: Permohonan tidak diluluskanjika:

Note: Application is not approved of:
aj Meinpunyai masalah Nampak dua linej, rabun warna at au rabun malam
Hos diplopio, colour blindness ornight blindness
b) Gagalujian medan pengllhatan (UjianKonfrontasi) bila dibandingkan dengan pemeriksa; Tidak normaljika
kurangdari30% daripemeriksa
Foils tile visualfieldtesting (Confrontation test);Abnormoly'less than 30%from examiner
cj Gagal mengenalpastidengan topat sekurang-kurangnya 4/17 plat warna ishlhara at au Ieblh
If OPP"contis not obje to recognize correctly 41z7 or morelshlhoro plates
dj Tahap penglihatan me Iebihi6/12 pada salah satu mata, dengan atau tanpa cermin mata at au kanta Iekap
Visualocuity exceeds 6/12in orleost one eye, with or without glosses or contactlenses
Seksyen2: Pendengaran Arahan: Sila tandakan (XI pada ruang berkenaan
Section 2: He@ring instruction: Please in ork (Xiin the relevant boxes
Tellnga kanan: ' Tellnga Kiri:

Right eon Left eor;
Ya/ Yes Tidak/ No Ya/ Yes Tidak/ No
,. 2. Kebolehan mendengar bisikan tanpa at au dengan
alat pendengaran
.. ..
Ability to he or whisper without or with he onrig old
Pendengaran normal: aj Kebolehan mendengar bisikan
Norm@I Hearing: Ability to hear whisper
by Dengan tellnga bertentangan ditutup
With opposite eor oreluded
d Dalam billk senyap
in a quiet room
d) Pada jarsk 0.6 meter
At o di^tonce of 0.6 meters
Permohonan tidak dilu!us kan Iika pemohon tidak dapat mendengar bisikan.
Applicotion not approved fy'the OPPlic@ntis unob!e to hear whisper,
3/9
SARINGAN 51NDROM 1< ESEl<ATAN PERNASAFAN TIDUR BERDENGKUR (OSAj
.
instruction/ Arahan: Circle your answer/' bul@tknnjowopan and@

13. Snoring/ beadengkur
Do you snore loudly (louder than toIking orloud enough to be he ord through closed dqors)?
Adakah anda beadengkur dengan kuat (kuat dari bercakap at au cukup kuat untuk didengari dengan pintu bilik
ditutup)?
Yes/Ya No/Tidal<
1.4. Tited/ Penat

Do you oftenjeel tited, fatiûed, or sleepy during daytime?
Adokah ondo kerop penot} fernoh, let^^ of slanghori?
Yes IYa No/Tidak
15. Observed/ Pemerhatian

Has anyone observed you stop breothing during your sleep?
Adakah sesiapa memerhati ateu memberitahu anda kelihatan Seperti berhenti bernafas ketika tidur?
Yes/Ya No/Tidal<
1.6. Blood pressure/ tekanan darah

Do you have or ore you being treatedfor high blood pressure?
Adakah anda mein punyai masalah darah tinggiatau ada mendapat rawatan untuk masalah tekanan darah tinggi?
Yes/Ya No/Tidal<
1.7. BMl
BMl more thon 35?

BMl me Iebihi 357
Yes/Ya No/Tidak
1.8. Age/ Urnur

Age over 50 year old?
Urnur meIebihi 50 tahun ?
Yes/Ya No/Tidal<
1.9. Neck circumference/ Ukuran Iilitan Ieher

Neck circumference greater than 40 cm?
Ukuran Iilitan Ieher me Iebihi 40 cm?
Yes/Ya No/Tidal<
20. Gender/ Jantina

Gender mole?
Jantina Ielaki?
Yes/Ya No/Tidalc
High risk of OSA: answering yes to three or more items

Low risl< of OSA: onswering yes to less than three items
TOTAL SCORE/ JUMLAH MARl<AH:

RESULT/ KEPUTUSAN: High risl(/' Be risko tinggi
(circle/bulatkan) Low ris1(/ 1<urang berisil<o
4/9
,
.
Pictorial IEpwortt:I Sleepiness Scale
I^11^:,,__.., Oat^,,, I:,,/ . *g%^^=all*a: Dale o1B!!all: _/ I

in contrast to just fealing fired, lion/ Ifteiy are >bÎ to daze on' or fat asleep in the rollov, f situations'?
E\, en it von have not don^ some of tile, se Ish I*:}$ recîn:>,: I, \, to urui^: ou! how, 11.5J, UNJ^ affect you,
Use the following 5041^ to cmQose the most appropriate number for ea:Ih situation.
I Na chance Slight Mad^dale
Denri:I^'y
situation 11Zl, ^:t; or do^11:9 1:1 el, ^tie^. cha. nc^ would doze
.. ..
Sitting ^Bit*
reading
, "' ^,; ,~ -^^,, . . .^t, , . ^;^.
IfL';31ching TV
Sitting mai;:ive in a
I^"" , . ~ ' , l^\. ~ ' ' ' I^;: :
^:ill ,-~I"I ^\:11- ,;!I
public piaoo
(e. g. Theatre or a
meetng}
F1. S a; pass^raget in . <1^^+<!> . <:1>+<!> ' '^; * <1> . <^^ --.<!>

a car for art how
^
without a break
-^@ @ ~ 0- .-^ . ,
I. >, 3'19do, Milo testii,

I. . ^<9^ . ^ O
.:,,, F. IÎ
Ihe afternoon\16beat
dictams^^no^s .,, .... ..-
permi!
. -. 0,
Î^ ~ ^Î- ~!^
Sitting Bald talking
10 Born'eono
.
.^
Sitting quietly 8119r . (^:) <0 '

ît, ît'I .\
.-. -," ^..
,unch wi'""
Îôho! I
in ^, Car. V, ;'lite . 11
slopped for a to, \.
minutes lab tram^
.^^^^^ II. __ , * ' ^^^ ,^^-^f,
Epworth Sleepiness scale
0-9 NORMAL
10-13 MILD
1.4 -1.9 MODERATE
20-23 SEVERE
5/9
Sel<syen3: Neurologi dan Must<ulosl<eletal Arahan; Sila tandal<an (X) pada ruang berl<enaan
.
Section 3: Neurology und Musculoskeletol instruction: Please mark (XI in the relevant boxes
Ya/ Tidak
Yes/
No
21a.
ILLj 11^ Pernah mengalami serangan epilepsi daiam 1.0 tahun kebelakangan ini? (Jika tidak, terus ke
soalan n0.22)
Had any epilepsy attackin the past to yeors? (If the answer is no, proceed to question
n0.221
2, .b. Sekiranya "Ya" 511a nyatakan tarikh serangan terakhir : I I
If the onsweris "yes't please specify the dote of the lost attack:
21. c.
E:^ .Î Menerima rawatan ubatan untuk masalah diatas?
Received treotmentfor the above problem?
21d.
Iika "tidak" menerima rawatan ubatan, nyatakan tankh akhir rawatan : I I
Ifthe answer is 'No'; please specjf'y the lost dote of treotment:
22.
Meinpunyai seiarah I tanda I gela!a untuk masalah seperti tersenarai di bawah :
Hoving history/signs/symptomsjor conditionslisted below:
23a.
I^ I^ Serangan peningI vertigo dalam 6 bulan Iepas?
Dizziness/ vertigo in the post 6 months?
23b.
I^ I^ Penyakit serebrovaskular (StroI an gin ahmar, pendarahan otak) at au rasa kebas dan Iemah
di tangan/ kaki?
Cerebrovosculor Ofseoses istroke, Intro Cranial Hemorrhage) or numbness and weakness in
the arms/legs?
23c.
I^ I^ Migrain at au sakit kepala Yang diiringi dengan masalah lain?
Migraine or headache, associated with other conchtions?
23d.
^ I^ 1<ecederaan 1<epala I IeherItulang belakang?
injury to the head/neck/spine?
23e.
1.11 I^ Pembedahan di bahagian kepala?
Sungicol procedures to the head?
24. Ujian Rhomberg: I. Normal
I. Abnormal
Normal Abnormol
Rhombergfs: Test:
25. SIStem Muskulosl<eletel: I. Normal
. Abnormal, nyatakan:
Normol Abnormal specly'y:
MusculoskeletelSystem:
Sei<syen4: 1<ardiovaskulor Arahan: Si!a tendal<an (Xi pada ruang bentenaan

Section 4: Cord^^vnsculor Instruction: Please moat (XI ^^ the relevtint boxes
26. Lokasi Apex Beat :
Apex Beat Location:
27. Bunyijantung: . Normal . Abnormal
Heart Sounds: Normol Abnormal
28. Murmur:
. Normal
^ Abnormal, nyatakan:
Murmur: Normal~ Abndrma4 specify:
Setsyen5: Respiratori Arahan: Sila tandal<an (X) pada ruang berkenaan

Section 5:Respirotory instruction: Please marlc (XI in the relevant boxes
29. Bunyi pernafasan: I^ Normal 11^ Abnormal, nyatakan:

Respirotory sounds: Normol Abnormal specify:
Nota: Permohonan tidak diluluskan jika sistem pernafasan adalah abnormal,

Note: Appl^âtton not approved if there is any abnormality in the respiratory system
6/9
.
,
Se!<syen 6: DiabetisMelitus Arahan: Sita tanda!<an IX) pada ruang berkenaan
Sectibn 6: Dinbetes Men^tus Instruction: Please mori< (Xi in the relevant boxes
Ya/ Tid a k/
Yes No
30.
^ I. . Pemohon menghidap penyakit Diabetes?
Applicont suffering from DJ^betes?
31. .
I^ I^ Jika Ya, adakah pemohon mengambil suntlkan insulin?
!f Yes, is the OPPl/cont taking msul^h inI'ections?
32a.
I^ I^ Pernah menga!ami episod hipoglisemia daiam masa 6 bulan yang iaiu?
Had ony hypoglycemic episodes in the post 6 months?
32b.
I^ I^ Sal<iranya ada mengalami episod hipoglisemia, adakah memerlukan bantuan daripada
orang lain semasa episod itu berlaku?
Require assistancefrom another person during a hypoglycemic ep^sode?
H. UJIAN MAKMAL (untuk. dilengkapl<an o1eh pengamal perubatan Yang memeril<sa pemohon)
LABORATORY TESTS fro be completed by the medical practitioner!
Ujian darah untuk Diabetes Mellitus

Blood testfor Dinbetes Mellitus
HbAl. c : mmol/L
^;;^;::$î;^Î'^'^1.1^^;fy!;'ME^!.^'ISI':BO;RA:^!'(^^^'E:I^-^!^!1<11. NAN;^^;SE'j^:;v. :^1<1Î^, loin^^111. <.,..:-\'-*:;!@tin^^.:!;I

PERHATIAN:
(i) 80rang ini perlu -diisi apabita:
a) anda memohon lesen vokasioanal baru
b) anda me in perbaharui lesen vokasional
c) anda menambah kelas lesen vokasional
d) anda memohon salinan lesen vokasional
(ii) Gunakan SATU borang untuk SATUjenis transal<si sahaja,
(iii) Tulis dengan terang danjelas, gunakan HURUF BESAR.
Panduan mengisi borang di BAHAGIAN A : 10nis Permohonan

Gunal<an kod berikut dan pilih satu sahaja:
" ...
!I;^jut>^. IÂAj!!F, EÎ^1,161ylAt!AN. :AWAIVi' . KENOît^. AN ^SARANiq. Alt' .,...

.. ..
KOND!J!(;ToR:'.: .,
.
.
I- I
02 PermOhona. n Lesen Baharu 01 Permohonan Lesen Baharu 03 Perm. ohonan Lesen Baharu
,. 2 Pembaharuan Lesen 1.1 Pembaharuan Lesen 1.3 Pembaharuan Lesen
22 Tambah Lesen 21 Tambah Lesen 33 Salinan Lesen
32 Salinan Lesen 31 Salinan Lesen 63 Baharui dan Salinan Lesen
52 Baharui dan Tambah Kelas Lesen 51 Baharui dan Tambah Kelas
Lesen
62 Baharui dan Salinan Lesen 61 Baharui dan Salinan Lesen
66 Tambah Kelas dan Salinan Lesen 65 Tambah Ke!as dan Salinan
Lesen
69 Baharui dan Tambah Kelas dan 68 Baharui dan Tambah Kelas
Salinan Lesen dan Salinan Lesen
7/9
.
BAHAGIAN I: PENGESAHAN 1<ELAYAKAN

,
($^
^^@
^,%
*~,/
./
PEMERll<SAAN 1<ESIHATAN
(I PI L8A)
I. PENGESAHAN 1<ELAYAKAN (untu!< dilengkapl<an aleh pengamal perubatan yang memeriksa pemohon)
CERTIFICATION OF FITNESS (to be completed by the attending med^ûlprtictitioner)
Saya dengan ini mengesahl<an bahawa saya telah memeril<sa pemohon
I hereby declare that I have examined OPPficant (Nomo Pemohon/Name of OPP/Itand
No. Kad Pengenalan: dan mendapati pemohon in I adalah:

NRIC: and certify he/she :
I. . Laval< untul< memohon lesen me mandu vol<asional

Fit to apply for vocational driving 11ênse
I^ Tidal< laval< untuk memohon lesen me mandu vol<asiona!

Unfit to apply for vocotibnol driving license
11:1 Tidal< laval< untul< memohon lesen me mandu vokasional untuk sementara
Tempororily Unfit to apply for vocational driving litense
Dirujuk 1<epada:
Referral to :
Diagnosis:
Catatan:
Tandatangan: No. Pendaftaran Klinik:

^gnature: amic Registration No. :
Nama Pengamal Perubatan: Bayaran Yang Dikenal<an:

Name of Medical Practitioner: Payment Being Charged:
No. Pendaftaran Penuh: No. Resit:

FullRegistrotion Number: Receipt No. :
NOTA:
01 Hanya pengesahan (Bahagian I at au11 perlu dikemukakan Icepada Jabatan Fengangkutan Jalan UNl
tiny Feinohon Yang menerima pengesahan "ridok Joyok untuk memohon lesen memondu VCkosion@! untuk sementaro" pada Ballagian I
hendaklah me inbuat pemeriksaan kesihatan semula bagi mendapatkan pengesahan dl Bahagian I
11ii) Feinohon Drang Kurang Up aya 101<U) hanya laval< memohon lesen PSV ITel<si/ Kereta Sewa/ Teksi Mewah/ E-HailingI sahaja
BAHAGiANI: FENGESAHAN SEMULAl<ELAYAKAN
@ PEMERiKSAAN 1<ESIHATAN
(I Pi L8A)
J. PENGESAHAN KELAYAKAN SELEPAS INTERVENS! (untul< dilengkapl<an o1eh pengamal perubatan yang memeriksa
pemohon)
CERTIFICAnON OF FITNESSAFTER INTERVENTION Ito be coinplet^d by the titrend, hg med^^@IPr, "trimner)

Saya dengan in I mengesahkan bahawa saya telah memeriksa pemohon
Ihereby declare that Ihave examined OPPl^ânt(Noma PemohonIName o10pplitont)

No. Kad Pengenalan: dan mendapati pemohon inI adalah:
NRIC: and certify he/she ..
I^ Lavak untuk memohon lesen me mandu vokasional

^t to apply for vocotibnol driving license
I^ Tidak lavak untul< memohon lesen me mandu vokasional

Unfit to apply for vocational driving Jitense
Diagnosis:
Catatan:
Tandatangan: No. Pendaftaran Klinik:

^gnature: Clih^^ Registration No. :
Nama Pengama! Perubatan: Bayaran Yang. Dikenakan;

Name 'of. Med^^dipractitibner: Payment Being Charged:
No. Pendaftaran Penuh: No. Resit:

FullRegistrotion Number: Receipt No. :
NOTA:
(1) Hanya pangesahan (Bahagian Iatau11 perlu dikemukakan kepada Jabatan Pengangkutanialan (, PI)
(Ii) Pemohon Yang menerima pengesahan "ridok Joyok untul< memohon lesen memondu vokosionol untok sementar@" pada Bahagian I
hendaklah meinbuat pemeriksaan keglhatan semula bagi mendapatkan pensesahan di Bahagian J
till) Pemohon Orang Kurang Up aya (OKU! hanya laval< memohon lesen PSV (Teksl/ Kereta Sewa/ Teksl Mewah/ E-Hailing) sahaja
LAM PI RAN D
Memeall lEx:amimi, atton 8'11. and. ants
IF o r, ...,.,_.,..,._,... _ _ _ _..._ ,.,_ ... . , . ., _, _._.. .,. _ _ .._ _._. _._ _. ,_ . , . _ __. ,_ . _..,._ _. _, , . _ __, ..,_ ,
V'<>-c, -^;^,,&-ô14, ,-a^,, t^

"pt, ^v^^;t $ I, ,I^cît^^^^^\$^^,^-'13,
a. ^,
^ -,!^". ' .^,"'

^. =^: ,^ .^.
_,=E^ ,^.. - 'r^- '=^' ^"'
~ ~e. ! . ' I^:' '~' Î ' ~ '
~" ""' ' ,,.,,, ,_1 ' ~ '

- -,=- ~' ,,-,.~ - -
,,., ,. _.*.^--,==.
-=!,^;I=^
^:'. ~' _ .*.^:^ I .-' ^.' ' '
Ie=;' ^=:. '^' ' ~~ *^ .,,,

, ; .-- ,^, '~ ' .. ^.., F*
*e'E '^^' ' ~ """ *a, * I^,. .,,. _
_,,;.,^j -^. ^,-= ,=,. -^ . . ^^,,,,-
_^;:,=, ,, ,=,. -_:.. -^; :.: -: I. ^:;; ~ L

I '~^, ' ~'"" '.^ ~' ' "
,,,,,,,,^; "*!,,,,,_ . _,,,.,,, _, ,,, ,,,

,,î::,*,',;~,r .. I:,..- - .,* ^;^ ~ .,^.--r
* ..~ .' ,,I^,,"~"
";. j^,...,,,,. .,._,.^^,,
. "'~_, ^^!i ,"*;,,,,,:;^^:
ii:.^;^^'
I"'
' I'!'-' ,' ,' ..' .' ^,^-
"""' Î-
""'-^:*-
^!Î^;"'~ ~~::-.=^.^^.,
^^;!^^*-^,,,,^ ~ F ^^,.. I+:;.^=:---
I^!:^,, ,
^!I-:
^;;, ,^::.j -=.=.;:*;
- , 4^,,,!{!^-**^'
.-._,^.;....' .,"' ' ^!^,,^,,*
-, .".-"^..^^-^,,,
-^-e.
~ -- - 1:1"î; Î ^Q^^;...
=-. ':;,!.=^
,.^;..;.;,!.'~ -- .~, ,~ '^^.
= .^"',^^!=, -,:*I
-.
ae^*!,^lionîn'Calm
'î^^!.;!:IÎîÎÎ WE, ^ .^"^^'*'1<11~
*.-^.~;81^';*";
^15^56'-Garnic!^ Flirts!"tI
;'=":=='
'~:"*:'
. :.^jib. _-,:-,,_
"~""""'*,;"'1"
,,,,,,. _'*,,---;**;
. ._ , ,^!P
mini;!fu^ of
' '"*"""".~*,"kiwih ,*^-.^!. I. :"^:,.^,^.
^,="'^'11^^p, ^- ' ' .~ '~ "!'^*"'
;","'
' ' "'9"!^>, .,,,-^.. ;,,.~:.'^,;;^,,
^';"'>'*,^",'~
,,.,,,,, ,,,',, 11, ,'^'
,,,,., ;,,.~^,,!~','^;
,, 4*
a*-**^!^-~'
e^"*'- '. =. ,;-_, -
11^;=.,.I" ,,,,,.,,,
~,:",,
.^:, ',.
.,!^'.,,,. I*^^" "'^^"',,;;,,,~ i' ~~,;,*^,
' I ~ , ,
,.,=,'
Preface 4
Participant of Medical Examination Standards For 5
Vocational Driver's Licensing Technical Committee

Expert Committee 7
Medical Examination Standard 10
Guidelines for Medical Examination of Vocational Drivers 25
Medical Examination Format Process 26
Process Flow 29
References 31
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVER'S LICENSING Page 2

Preface
v^; ^<:
*
^
.<=;;,.*
Dato' Dr. Hasan bin Abdul Rahman

^: Director General of Health, Malaysia
I^*;~* *-'-}*. 63
^-. -(
Medical standards are required to assess certain

would like to take this opportunity to
conditions that may impair driving ability.
coinmend the Occupational Health Unit, Disease Stringent standards are required for drivers of
Control Division, Ministry of Health, Malaysia, for commercial vehicles due to the potential
developing these much needed standards, derrimental threat to body and life.
Medical examination for the assessment of
fitness of vocational drivers is a very important These standards have been developed by an
process in the application of a vocational expert committee that has studied the needs and
license. Medical conditions may have a potential requirements of vocational drivers while also
impact on the driving ability of a person and if not taking into consideration existing standards in
addressed. this may prove dangerous to the many other countries.
public.
The Ministry of Health is committed to ensuring
Driving a motor vehicle is a complex task that the health and safety of the public is
involving perception, appropriated judgement, maintained and thus the need for adherence to
adequate response time and reasonab coinpu ry standard
physical capabilities. A range of me cal
' conditions may impair- bne's driving- bility
resulting in a crash causing injury or death

Director General of Health. Malaysia
-+

PARTICIPANTS OF MIEDICAL EXAMINATIONSTANDARDS FOR
VOCATIONAL DRIVl^R'S LICENSING COMMITT:11:11!;
ADVISORY
Deputy Director General of Health (Public Healthy
Ministry of Health, Malaysia
VICE CHAIRPERSON
Dr. Balachandran 'Satiamurti Deputy Director, Disease Control Division
Non Coinmunicabe Disease Section
Disease Control Division
Minist of Health. Mala sia
VICE CHAl RPERSON
Dr. Sirajuddin bin Hashim Senior Principal Assistant Direc!or
Occupational Health Unit, Disease Control Division
VICE CHAIRPERSON
Dr. PriyaRagunath Senior Principal Assistant Director
Occupational Health Unil, Disease Control Division
TlDC11NICAL COMMITTEE
TECHNICAL COMMITEE
Dr. MohdKhairi bin Yaacob Director, Medical Practices Division
Dr. MohdAnis bin Harun Principal Assistant Director, Medical Practices
Division
Ministr of Health, Mala SIa
Assistant Director, International Health Unit
Dr. Alias bin Abdul Aziz Disease Control Division
Occupational Health Unit, Disease Control Division

Dr. HanizahbintiMohdYusoff Ministry of Health, Malaysia
Dr. ZairinabintiAbd Rahman Senior Assistant Director, Occupational Health Unit

Dr. An it a bintiAbd Rahman Senior Assistant Director, Occupational Health Unit

Minist of Health, Mala sia
En. Azmi bin Awang Road Transport Department, Malaysia
En. Zulhasmi bin Mohamad Road Transport Department, Malaysia

TECHNICAL COMMITEE
Dr. Nonen Mohamad Research Officer
Malaysian Institute of Road Safety Research
Dr. Muhammad FadhliMohdYusoff Research Officer
Malaysian institute of Road Safety Research
Dr. NoridahbintiMohdSalleh Principal Assistant Director
Family Health Development Division
Dr. Fauziahbinti Zainal Ehsan Principal Assistant Director
Family Health Development Division
Oato' Dr KhooKah Lin President.
Malaysian Medical Association
Dr. Jagdev Singh Chairman,

Society of Occupational and Environmental Medicine
Dato' Dr Teoh Shing Chin Malaysian Medical Association

Dr. S. R. Marialan Malaysian Medical Association
Dr. Nirmal Singh Malaysian Medical Association

Dato' Dr. NKS Tharmaseelan Malaysian Medical Association
Dr. Molly Cheah Bee U President

Primary Care Doctors' Organization, Malaysia
Dr. Tengku Mohamed bin Tengku A. Jalil Primary Care Doctors' Organization, Malaysia
Dr. Nik Khairol Reza Bin MohdYasin Senior Principal Assistant Director, Occupational
Health Unit
PrindpalAssis!ant Director, Occupational Health Unit

Dr. Pravin all Muniandy Disease Control Division
Dr. N. Ganabaskaran President (2019)
Dr. ThirunavukarasuRajoo Malaysian Medical Association
Dr. L. Sivanesan Malaysian Medical Association
Dr. ShadudinNordin Public Health Physician

Seiangor State Health Department
Dr. MohdFaid Abdul Rashid Public Health Physician

Negeri Sembilan State Health Department
Dr. Lim Jac Fang Public Health Physician

Sabah State Health Department

EXPERT COMMITTEE
NEUROLOGY REQUIREMENTS
Dato' Dr. Hanip bin Rafia Senior Consultant and Head
Department of Neurology
Hos ital Kuala Lum or
Dr. Mohd. Safari bin MohdHaspani Senior Consultant
Department of Neurosurgery
Hos it al Kuala Lum or
Dr. Johan Siregar bin Adnan Senior Neurosurgery Consultant,
HDs ital SultanahAminah, Johor Bharu
Prof. Raymond Aji Zaman Senior Neurology Consultant
Hos it al UniversiliKeban saan Mala sia
Prof. Dr. Jam Malin bin Abdullah Senior Physician,
Department of Neurosurgery,
Hos itsI UniversitiSains Mala sia
Dr. AzmiAbd Rashid Senior Consultant,
Malaysia Society of Epilepsy,
Damansara S ecialist Centre
Prof. Dr. Goh KheanJin Senior Consultant,
Malaysian Society of Neuroscience,
Universi! Mala a
Dr. Santhi a/p Datuk Puvanarajah Senior Neurology Consultant
Senior Neurology Consultant
DrSa iahSa uan Hos it al Sun ai Bu!oh
Dr. MohdSufianAdenan Senior Neurology Consultant
ORTHOPAEDIC REQUIREMENTS
Prof. Dato' Dr. Tunku Sara bintiTunkuAhmad Consultant Orthopaedician and President
Malaysia Society of Orthopedic
Department of Orthopaedic Surgery
Universil Mala a
Dr. Se To Boon Chong Head of Department of Orthopaedics .
Hos its I Pulau Pinan
Dr. Zulkiflee bin OSman Head of Department of Orthopaedics
Dr. Ramli bin Baba Head of Department of Orthopaedics
Hos it al Sela an
Dato' Sri Dr Premchandran all P. S. Menon Senior Orthopaedic Consultant and Head of
Department of Orthopaedics
Hospital TuankuAmpuanAfzan, Kuantan
Datuk Dr. N. Sivapathasundarama/I Nadarajah Head of Department of Orthopaedics

Hos its I Me Iaka
NEPHROLOGY REQUIREMENTS
Senior Consultant. Department of Nephrology
Daio' Dr. ZakiMorad bin Mohamad Zaher Hos ital Kuala Lum or
Dr. Ravindran all Visvananlhan Consultant Nephrologist
Dr. Tan ChweeChoon Consultant Nephrologist
President. Malaysian Society of Nephrology
Hos ital TunkuAm uanRahimah, Klan
Dato' Dr. Orig LokeMeng Senior Consultant Nephrologist
Hos ital Pulau Pinan
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVERS LICENSING Page 6

RESPIRATORY REQUIREMENTS
Daio' Dr. Jeyaindran Tan Sri Sinnadurai Head of Department of Medicine
Hos ital Kua!a Lum or
OatinDr. AziahAhamadMahayiddin Head Institute of Respiratory Medicine
Jalan Pahan , Kuala Lum or
Prof. Liam Chong-Kin Senior Consultant President, Malaysian Thoracic
Society
Universil Mala a Medical Centre
Dr. Christopher Lee Kwok Choong Head Department of Medicine
Hos itel Kuala Lum or
Dr. George Kutty SImon Senior Consultant Respiratory Physician
AIMST Universi!
Senior Consultant Respiratory Physician
Dr JamalulAzizi bin Abdul Rahman Hos ital Setoan
OTORHINOLARYNGOLOGY REQUIREMENTS
Dr. Abd Maid bin Md. Nasir Head Department of Otorhinolaryngology
Dr. SitiSabzahbintiMohdHusni Head Department of 010rhinolaryngology
Hos it al A10rSetar
Head Department of 0101hinolaryngology
Dr. Faridah Hassan Hos its I Sela an
Head. Department of Otorhinolaryngo!ogy
Dr ZulkifleeSalahuddin Hos itsI Ra'a Perem uan Zainab 11, Keiantan
VISUAL REQUIREMENTS
Dr. Goh Pik Pin Consultant Ophthalmologist
Hos ital Seia an
Dr. Mariam binti Ismail Consultant Ophthalmologist
Hos it al Seia an
Dr. Fang Seng Kheong Consultant Ophthalmologist
Hos its I Mala TunHusin Onn
Dr. Wong Jun Shyan Consultant Ophthalmologist
MMA
Dr. MimiwatiZahari Consultant Ophthalmologist
Universit Mala a Medical Centre
Dr. Mohd Aziz bin HUSni Consultant Ophthalmologist
Hospital Selayang
Dr. Nor FarizaNgah Consultant Ophthalmologist
Hospital Shah A1am
OPTOMETRIST RERQUIREMENTS
Optometrist
Dr. Rokiah Qinar Hos ital Kuala Lum or
Optometrist
PuanCheRuhaniCheJaafar Hos ilal Kuala Lum or
Optometrist
PuanHanizahH'Suboh Hospital Kuala Lumpur
Optometrist
PuanS uhairahHamzah Hospital Kuala Lumpur
Secretary
En. Ismail Shukor Malaysian Optical Council

PSYCHIATRIC DISORDERS, ALCOHOL AND DRUG ABUSE
Senior Consultant and Director
Dato' Dr. Suarn Sin h Hos it al Baha ia, Perak
Head Department of Psychiatry
Dr. Fauziah Mohammed Hos itsI Ten kuAm uanRahimah, Klan
Senior Consultant, Department of Psychiatry
Dato' Dr. H' Abdul Aziz Hos itsI Kuala Lum or
Dr. Ben'amin Chan Teck Min Hos it al Permai Johor Bharu
Prof. Dr. Abdul Hamid bin Abdul Rahman HDs it al UniversitiKeban saan Mala sia
Dr. Ra'in der Sin h Hos ital I oh
Consultant Psychiatrist and President
Prof. Dr. ManiamThambu Mala sian Ps chiat Association
Consultant Psychiatrist
Dr. Toh Chin Lee Hos ital Sela an
Consultant Psychiatrist
Dr. N Cha Nee Hos itsI Sela an
CARDIOVASCULAR AND HYPERTENSION

Consultant and Head Department of Cardiology
Dato' Dr. Omar bin Ismail Hos ital Pulau Pinan
Consultant Cardiologist and President
Dato' Dr. AzahariRosman Presiden Mala SIan SOCiet of H ertension
Consultant Physician
Dr. Ngau Yen Yen Hos it al Kuala Lum or
Director Faculty of Medicine
Dr. MohdAriffFadzli UniversitiTeknolo i MARA
Consultant Cardiologist
Dato' Dr. Abd. KaharGhapar Hos its I Serdan
DIABETES MELLITUS AND OTHER ENDOCRINE DISEASES
Consultant Physician and President

Prof. Dr. Ikram Shah bin Ismail Mala sian Diabetes Association
Dr. K. Sree Raman HDs ital Seremban
Consultant Endocrinologist
Dr. ZanariahbintiHussin Hos it al Putra'a a
Dr. G. R. Letchuman HDs it al I oh
PATHOLOGY REQUIREMENTS
Head Depîn meht of Pathology
Dr. Muhammad Arif bin Mohd. Hashim Hos it al Kuala Lum or
Medical Assistant Pat0to9y Laboratory
EncikKamarulzaman Hos ital Kuala Lum or
REHABILITATION REQUIREMENTS
Dr. YusnizabintiMohd .Yusoff Senior Consultant of Rehabilitation Medicine
Hos it al Rehabilitation Cheras

MEDICAL EXAMINATION STANDARDS
This medical examination standards are to be used to determine the fitness level of the applicants.
Any applicant not fulfilling the criteria stated will be considered as unfit to apply for a vocational
driving license.
CHAPTER I: VISUAL DISORDERS
CONDITION MEDICAL STANDARDS

License may be granted if visual acuity is of at least6/12
in VISUAL IMPAIRMENT
in each eye (i. e. each eye must have at least 6/12,619,616
or better, tested separately) with or withoutcorrective aids
such as glasses or contact lenses.
Test required :
Visual acuity test done at 6 meters, using
standardsnellen's Chart either number, alphabet, or
illiterate EChart or chart with logarithmic progression, such
as in the ETDRS standards, at the distance appropriate for
the
.chart. Test one eye at a time. A person who makes
more than two errors on the line wi!h five characters
should be regarded as having failed that line. Drivers who
requirecorrec!ive lens to achieve maximum visual acuity
should be required to wear their corrective lenses while
driving, Charts designed to be used at 3m or greater
are recommended.
License may be granted if the binocular visual field

,. 2 VISUAL FIELD DEFECTS
hasan extent of at least 120' along the horizontal meridian
(Disorders such as Severe Bilateral
Test required :
Glaucoma,
Severe Bilateral Retinopathy, Relinitis Visual fields is done with both eyes open and may
PigmentOSa and other disorders producing be initially screened by Confrontation test. Any person
field defects including partial or complete whohas or is suspected of having a visual field defect
homonymous hernianopia quadrantanopi or should be referred for expert assessment by an Optometrist
complete bitempora!hernianopia) or an
Ophthalmologist for an objective test using an

automated perlmetry with Goldmann Standard testing
conditionssuch as Humphrey, Octupus, Kowa Automated
Visual Field Analyzer and others, Use the Esterman function
Testand test with both eyes open.
Not qualified for licensing if diplopia is present within

1.3 DIPLOPIA
'the central' 40' primary gaze (i. e. 20' to the right, left,
above and below fixation, even if the diplopia is
(Double vision) correctable with a prism).

Not qualified for licensing if severe protanopia (severe
,. 4 COLOUR VISION DEFECT
red defect) is presentThose who fail to recognize correctly
4 plates of the ishihara Test for Colour Deficiency (38
plates) should be referred to the specialist for further
evaluation of colourvision. Confirmatory tests forcolour
vision includeFamsworth-Munsell Dichotomous D-15
Test. SppPseudolsochromatjc part I & part 2 and
Fransworth-Munsell 100 Hues Test.
1.5 NIGHT BLINDNESS

Not qualified for licensing if night blindness is present
Currently there are no standard tests or procedures that
can be recommended for assessing night blindness.
Condition is elicited from history.
CHAPTER 2: 0TORINOLARYNGOLOGY DISORDERS
2. f HEARING Loss
Compliance with the standards should be clinicalIy
assessed initially and possible hearing loss measured by
audiological testing that is performed by certified
personnel and using certified facilities
Note :
-"Certified personnel" are Audiologist's and certified

Audiometricians
-"Certified fadlities" are facilities that are certified by DOSH or
any licensing body
Not-qualified for licensing if- the person has an unaided

average hearing threshold level of equal to or greater than
60dB in the better ear.
(Average hearing threshold is the simple average of pure

tone air conduction thresholds at 500, 1000,2000 and
3000Hz).
License may be granted, taking into account the opinion

and endorsement of an ORL specialist and the nature of the
driving task, and subject to periodicreview if the standard
is met with a hearing aid.
Further assessment of the person may be arranged with the

RTD authority and advice may be sought regarding
modifications to the vehicle to provide a visual display of
safety critical operations.
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVERS LICENSING Page I O

2.2 VESTIBULAR DISORDERS

Note : Vestibular vertigo is vertigo caused by disturbances
of vestibular system.

and endorsement of an ORL specialist, Physician and the
nature of the driving task, and subject to periodic review:
For persons who have had vertigo caused by Meniere's
disease or recurring unheralded attacks of vertigo or are
free of vertigo for at leash2 months;
. For persons who have had one episode of vertigo

caused by Acute Labyrinthitis (deafness and vertigo), Acute
Neurolabyrinthitis (Vestibular Neuronitis), or any other type
of vertigo or are free of vertigo for at least 6 months;
. For persons who have had Benign Paroxysmal

Positional Vertigo (BPPV) only, free of symptoms and signs
of BPPV for at least 6 months.
The ORL specialist's opinion to be sought on :

. The nature of the condition and response to
treatment; and
The functional ability to operate the vehicle safely
CHAPTER 3: NEUROLOGICAL DISORDERS
3. , EPILEPSY
Free of epileptic attacks (including nocturnal attacks)
for at least 10 ears without medication.
3.2 FIRST EPILEPTIC SEIZURE/SOLITARY FIT License may be granted after taking
specialist's opinion, size and condition of duties
to be performed and hours of worked (with
conditions including limitedand/or restricted
use) :
. Person has had a single provoked seizure
event; and
. Provocative factors can be avoided reliably;
and
. Seizure free for I year; and
. Does not take anti-epileptic medication; and
. ' EG shows no epileptiform activity
Needs opinion from a physician whether the
3.3 Loss OF CONSCIOUSNESS condition will cause LOG or loss of ability to
(LOG) DUE To SIMPLE FAINT control a vehicle.
Loss OF CONSCIOUSNESS Suggested 6 months waiting period lapse from
DUE To UNEXPLAINED
SYNCOPE AND Low RISK OF
the time of the episode and complete
RECURRENCE
neurological examination.
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVER'S LICENSING Page I I

3.4 Loss OF CONSCIOUSNESS License may be granted if the result is
DUE To UNEXPLAINED negative and no medication is required to
SYNCOPE AND HIGH RISKOF control the condition.
RECURRENCE:
Certification should be deferred for at least 6
Abnormal ECG months until the driver has fully recovered from
that condition and has no existing residual
Structural heart disease complications and not taking medication to
control the condition.
Syncope cause injury
Note: Certification should be done by a
More than I episode in physician.
previous 6 months
Neurocutaneous sign
Abnormal cardiac findings

Known medical Conditions
License may be granted after taking into
3.5 CHRONIC NEUROLOGICAL account :
DISORDERS (e. g. . Response to treatment
Parkinson's disease) . Annual driver tester report
.
. Modification to the vehicle if necessary by

Rehabilitation Physician or Occupational
Therapist
3.6 LIABILITY To SUDDEN if condition is sudden and disabling, not

ATTACKS OF DISABLING qualified for
GIDDINESS AND FAINTING
licensing.
If symptom free and controlled for at least one

year, may
be considered.
License may be granted and certified by a

3.7 CEREBROVASCULAR Physician or
DISEASES Rehabilitation Physician, if satisfactory
(including Stroke due to functional recovery
Vascular diseases, intra is attained within a period of 6 months from the
Cranial Haemorrhage and date of the event.
Transient ischemic Attack)
I) During acute illness. must stop driving :

3.8 CENTRAL NERVOUS * For meningitis - 5 years without medication
SYSTEM INFECTIONS * For encephalitis - 10 years without
medication
2) If seizure occurs during or after

convalescence - must stop driving.
License may be granted if 10 years free of

attack without medication and do not cause
danger whilst driving. Also depends on the
residual physical disability as assessed by a
Physician or Neurosurgeon.
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVER'S LICENSING Page , 2

License may be granted following:
3.9 SPINAL CORD INJURIES I) A consultation with orthopaedic

PERIPHERAL NERVE Surgeon/ Rehabilitation Physician and an
INJURIES assessment by Occupational Therapist
2) Able to drive a non - modified automatic

vehicle
3.10 NERVOUS SYSTEM Not qualified for licensing until cleared by

TUMOUR
relevant Specialist.
3. ,, SERIOUS GRANIOSPINAL
Not qualified for licensing until cleared by
INJURIES
relevant Specialist.
(Operated intracerebral
Hematoma or Compound
Depressed Fracture or Dural
Tear with more than 24 hours
Post-Traumatic Amnesia)

relevant
3.12 NON TRAUMATIC
CRANIOSPINAL
Specialist.
HAEMORRHAGE
(e. g. Subarachnoid
Haemorrhage)
3. ,3 HYDROCEPHALUS
License may be granted if uricomplicated and
has no
associated neurological deficit.
3. ,4 COMPLICATED MIGRAINE
relevant
Specialist.
3. ,5 CEREBRAL PALSY
Not qualified for licensing unless cleared by
relevant
Specialist.
3.16 INVOLUNTARYMOVEMENT
Not'qualified for licensing unless. cleared by
relevant
Specialist

CHAPTER 4: MuscuLosKELETAL DISORDERS

Not qualified for licensing :
4.1 MuscuLosKELETAL
DISORDERS
I) If rotation of the cervical spine is clinicalIy
restricted to less than 45 degrees to the left and
right
2) If chronic pain and restriction of the

peripheral joint movement interfere with
relevant movements or concentration such that
the vehicle cannot be operated safely.
3) if there is ankylosis or chronic loss of joint

movements of sufficient severity that control of
vehicle is not safe.
4) Severe cervical myelopathy and

quadriplegia
4.2 ABSENCE OF UPPER LIMB OR Loss OF

UPPER LIMB FUNCTION
Not qualified for licensing
Only applied to car drivers,

4.3 ABSENCE OF LOWER LIMB OR Loss OF
LOWER LIMB FUNCTION
Licensing may be granted following:
I)A consultation with orthopaedic
Surgeon/ Rehabilitation Physician and an
assessment by Occupational Therapist
2) Able to drive a non - modified automatic car.
CHAPTER 5: PSYCHIATRIC DISORDERS

5.1 PSYCHIATRIC DISORDERS
, If the person has an Acute or Chronic
Psychosis (e. g. Schizophrenia, Bipolar Mood
Disorder), Depressive Psychosis; Organic
Psychosis (e. g. Dementia orDrug-induced
Psychosis etc. ); or
If the person is using or dependent on
psychotropic. drugs which will. impair driving
performance on a long-term basis; or
. If the person's judgment or perception,
cognitive or motor function is affected by a
mental disorder (e. g. Dementia, Post-Stroke,
Adult ADHD); or
it the person has any psychiatric disorder
with features such as aggression. violence etc.
which are hazardous to driving; or
, it the examining doctor believes that
there is a significant risk of a previous
psychotic condition relapsing.

CHAPTER 6: DRUG AND ALCOHOL ABUSE AND DEPENDENCY

6. , ALCOHOL ABUSE AND
DEPENDENCY
If there is alcohol dependency
. If the person has a strong history of

alcohol abuseand relevant biochemical findings

account appropriate specialist opinion, nature
of the driving task and subject to periodic
review:
. if the person has stopped drinking for a

substantial period (for at least 12 months); and
. Is compliant with treatment; and
, Shows no evidence of end organ
damage relevant!o driving; and
Shows no evidence of alcohol related
seizures for at least two years,
6.2 SUBSTANCE DEPENDENCEAND
ABUSE
If there is clear evidence of dependency or

persistent abuse of any psychoactive drugs.
accountappropriate specialist opinion, nature of
driving task and subject to periodic review:
. Persons who are compliant with treatment

for illicit drug addiction (including Methadone or
Buprenorphine medication) for at least 12
months; and
. The severity of the addiction(s). the

response to treatment and the driving
re uirements are taken into account.

CHAPTER 7: CARDIOVASCULAR DISORDERS

7.1 ANGINA PECTORIS
License may bb granted when free from
Angina for at least 6 weeks while on
medication, but if indicated, to perform at least
a resting ECG. A Stress Test or equivalent
diagnostic investigation may be required.
7.2 ACUTE CORONARY
Driving to cease for a minimum of 6 weeks -
SYNDROMES (ACS) return to driving will be permitted when the
person is symptom free, there is no other
disqualifying condition and the person is able to
complete the exercise ECG to the required
standards:
There is an exercise tolerance of greater
than 9 minutes (stage 3) on the Bruce Treadmill
Test
. Less than 2 mm ST segment depression
on an exercise ECG
in addition the LVEF must be > 40%,
7.3 ACUTE MYOCARDIAL Driving to cease for a minimum of 3 months -
INFARCTION
. return to driving will be permitted when the
standards :
. There is an exercise tolerance of greater
Test
on an exercise ECG
in addilion the LVEF must be > 40%.

7.4 ANGIOPLASTY
Driving to cease for a minimum of 6 weeks -
return to driving will be permitted when the
standards :
Test
on an exercise ECG
In addition the LVEF must be > 40%,
7.5 CABG
Driving to cease for a minimum of 3 months - '
return to driving will be permitted when the
standards:
Test,
on an exercise ECG.
In addition the LVEF must be ^40
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVER'S LICENSING Page I6

7.6 LEFT VENTRICULAR

Not qualified for licensing permanently.
ASSIST DEVICES
7.7 AORTIC ANEURYSM

The person should not drive for at least 3
months post - repair.
Not qualified for licensing if patient has a

large (more than 5.5 cm) Aortic Aneurysm,
Thoracic or Abdominal.
Periodic reviews are necessary.
7.8 CAROTID ARTERY STENOSIS Not qualified for licensing if symptomatic or
the degree of stenosis is severe enough to
warrant intervention.
License may be granted if symptom free after

repair or stent implantation.
7.9 PERIPHERAL ARTERIAL DISEASE

License may be granted if there are no
symptoms of severe limb 150hemia.
Not qualified for licensing if the person has

7.10 DEEP-VEIN THROMBOSIS (DVT)
Deep Vein Thrombosis which is liable to
recurrence or embolus.
7.11 ARRHYTHMIA
. if the person has a history of recurrent or
persistent arrhythmia, which may result in
syncope or incapacitating symptoms.
License may be granted when the

arrhythmia is controlled for at least 3 months or
the arrhythmia is successfully cured, provided
that the LV ejection fraction is satisfactory (i. e.
LVEF is > 40%) and there is no other
disqualifying condition.
7.12 PACEMAKER IMPLANT The person should not drive for at least 6
weeks after insertion of pacemaker and the
person is symptom free,
License may be granted thereafter provided

that there are no other disqualifying conditions.
7. 't3 SUCCESSFUL CATHETER License may be granted-if there are no'

ABLATION
recurrent symptoms for 6 weeks and there
are no other disqualifying conditions.
7.14 UNPACED CONGENITAL

Not qualified for licensing if symptomatic or
COMPLETE HEART BLOCK severe bradycardia (Heart rate below 30 beats
per minute).

7. ,5 BIVENTRICULAR PACEMAKER
7. ,61MPLANTABLE CARDIOVERTER
Not qualified for licensing permanen"y.
DEFIBRILLATOR (100)
7.17 PROPHYLACTIC 100 IMPLANT

7.18 HYPERTENSION
Not qualified for licensing if Resting Blood
Pressure consistently exceeds 180 mmHg
systolic or more, and/or 100 mmHg diastolic or
more;
. With or without medication or
. Medication causes symptoms which affect
driving
ability,
License may be granted if the person is

treated with Antihypertensive drug therapy and
the blood pressure is not greater than 150195
mmHg, Ideal blood pressure is less than
'40/90 mmHg.
7. ,9 CHRONIC AORTIC DISSECTION License may be granted :
, If maximum transverse diameter of the
aorta, including false lumen I thrombosed
segment, does not exceed 5.50m
. If blood Pressure is well controlled '20/80
mmHg).
License may be granted :
7.20 MARFAN'S SYNDROME
, If no major organ involvement and there is
n0 o1her disqualifying condition.

7.21 DILATED CARDIOMYOPATHY
If symptomatic and ejection fraction < 40%.
License may be granted, taking into
account the opinion of a cardi0to91st, and the
nature of the driving task, and subject to annual
review: If there is an ejection fraction of > 40%.
7.22 HYPERTROPHIC
Not qualified for licensing if symptomatic.
CARDIOMYOPATHY (HCM)
License may be granted if they do not have
more than
one of the listed criteria below:
I. There is no family history of sudden
premature deathfrom presumed HCM,
2. The cardiologist can confirm that the
HCM isAnatomicalIy mild.
3. No serious arrhythmia has been
demonstrated i. e. VentricularTachy "
arrhythmia excluding isolated
Ventricular pre-excitation beats.
4. Hypotension does not occur during the
completion of9 minute exercise testing.

7.23 HEART OR HEART LUNG
Not qualified for licensing.
TRANSPLANT
7.24 PULMONARY EMBOLISM

License may be granted, taking into
account the opinion of an appropriate
specialist, and the nature of the driving task,
and subject to periodic review :
. After an appropriate non-driving period
of a minimum of 6 months or as determined by
the attending doctor; and
. Depending on the cause of the
embolus and response to treatment.
7.25 HEART VALVE DISEASE

account the opinion of a Cardiologist, and the
nature of the driving task, and subject to annual
review :
. if the person's cardiologicat assessment

shows Mild Valvular Disease of no
haemodynamlcsignificance,
. Three (3) months following successful
surgery.
. Ejection Fraction > 40%.
7.26 HEART FAILURE
Not qualified for licensing if symptomatic.
License may be granted provided that the LV

ejection fraction is good i. e. LVEF is> 40%, the
exercise/functional test requirements can be
met and there are no other disqualifying
condition.
7.27 CONGENITAL HEART DISEASE

Not qualified for licensing when complex or
severe disorder(s) is (are) present after
assessment by an appropriate consultant.
Those with minor diseases and others who
have hassuccessful repair of defects or relief of
valvular problems, fistulae etc. may be licensed
provided that there are no other disqualifying
conditions. Periodic reviews in a be necessar
7.28 SYNCOPE DUE To HYPOTENSION Not qualified for licensing if the condition is
(VASOVAGAL AND AUTONOMIC DYSFUNCTION) severe enough to cause episodes of loss of
consciousness without warning.
MEDICAL EXAMINATION STANDARDS FOR VOCATIONAL DRIVERS LICENSING Page I9

CHAPTER 8: DIABETES MELLITUS AND OTHER ENDOCRINE DISEASES
8.1 GENERAL GUIDELINES FOR

Not qualified for licensing (for initial
DIABETES MELLITUS
application and
maintenance) if :
I. Hypoglycemia within the previous 6
months which requires help from another
person or producing loss of consciousness.
2. Hypoglycemia appearing in the absence
of warning symptoms (hypoglycemia
awareness).
3. Uncontrolled Diabetes: HbAtc > 12%
within the last 6 months.
4. There is presence of end organ effects
which may affect driving ;
. High risk Pro!iferative Retinopathy/
DiabeticMaculopathy
.
Peripheral Neuropathy or
CardiovascularDiseases with the potential to
affect driving(refer to particular section).
8.21NSULIN TREATED DIABETES

All applicants on insulin should be assessed by
MELLITUS
attending doctor trained in diabetic care.
Not qualified for licensing according to the

above mentioned criteria in 8. ,.
Further exclusion criteria for insulin treated

applicants :
Have less than 2 follow-up clinic visits
during the last year for diabetic care.
Because of the diverse manifestation of these
8.3 METABOLIC AND ENDOCRINE
DISORDERS (OTHER THAN
conditions, each person will require an
DIABETES) individual assessment regarding likelihood of
acute loss of control of their vehicle
If there is a real risk of acute loss of control

then the criteria would not be met; appropriate
specialist's opinion must be obtained.
Specific defects which may be associated

with an Endocrine Disorder may also need
evaluation, e. g. effects on visual field from
Pituitary Tumours or Exophthalmos in
Hyperthyroidism.

CHAPTER 9: RESPIRATORY DISORDERS
9.4 CHRONIC LUNGDISEASES

Drivers who are diagnosed with chronic
respiratory illnesses likely to interfere with their
(e. g Asthma, COPD, Interstitial
Lung diseases) ability to drive despite optimal therapy will not
be qualified for licensing.
Note:
Public health aspects must be considered
in drivers
9.2 RESPIRATORY FAILURE

If the person has severe respiratory failure.
If the person has unstable diseases requiring
oxygen therapy.
License may be granted on an individual

basis as assessed by a Physician or
Psychiatrist.
9.3 NARCOLEPSY/ CATAPLEXY

License may be granted on an individual basis
as assessed by a Respiratory Physician
CHAPTER 10. RENAL DISORDERS

,0.1 RENAL FAILURE AND OTHER
RENAL DISEASES , If the person has end - stage renal failure (requiring
dialysis) or advanced predialysis renal failure (GFR
< 20% of normal).

of a renal specialist, and the nature of the driving task,
and subject to periodic review:
. If the patient's condition is stable with limited co-

morbidities.

CHAPTER 41: MISCELLANEOUS

11.1 RESPIRATORYRELATED
SLEEP DISORDERS
Drivers who are diagnosed with OSA and require
treatment are advised to have annual review by a ORU
(OBSTRUCTIVE SLEEP APNOEA
Respiratory specialist to ensure adequate treatment is
maintained.
SYNDROME I OSA)
if the person has established Sleep Apnoea

Syndrome (Sleep Apnoea on a diagnostic sleep study
and excessive daytime sleepiness) with moderate to
severe sleepiness until treatment is effective.
. If there is a history suggestive of apno@a in
association with severe day time sleepiness, until
investigated and treated. Severe sleepiness is indicated
by frequent self-reported sleepiness while driving motor
vehicle crashes caused by inattention or sleepiness or an
Epsworth Sleepiness Scale score of >, O or OSA
syndrome screening indicating high risk of OSA.
License may 'be granted, taking into account the. opinion

of a specialist (Respiratory/Otorhinolaryngology) in sleep
disorders and the nature of driving task and subject to
annual review:
. For those with established Sleep Apnoea

Syndrome (Sleep Apnoea on a diagnostic sleep study
and excessive daytime sleepiness) who are on
satisfactory treatment.

C--DIDEL^11Ei^;I I^'DR. ^-^:ET^^:CAL
EXA^^,^^^:A^:110Î a^'
VDCAT. 101^ân in, Rit\FF*I^^!
^.
-, .-
- .e^",,-r ^-~
^=I~ ~ '"" '^!^. It,
.:Î. =.. a-. . I. E=It. ,,. ~
I^ I^-- ' .^;^:::~;"" '
" '=.;"F. I-~' I ~ ~'
~ - .;" ' '~^" I"'=I!^:I. ': î, ^;^;,-

^==-- _ I^.^': ^,,^.! ' - ;^._-
^!=^.,^,:^.,^"' ^;^'e^! '*^;^.
,;^^^= ^ -..,^^-
,,,,,,,.-,^;..,,., -,^^ ^!^
-^^:'*^!. I ,^;;:^.,
^;^^;^^,'
.!'^'^:", I^^^,;;^. *^*,!.^,:
- ---,..=,:^
^
,^.- T ^"'
^
~

Guml^LINES ^'ORil"lDDTCAL EXAMINATION
018' VOCATIONAL DRIVERS
INTRODUCTION
Medical examinations have been carried out as a requirement of the Road Transport Department (RTD),
for the application of vocational driving licenses. This was conducted using the JPJ L8A form for new
applications and the JPJ L8 form for renewal of licenses. Due to inconsistencies faced in the examinations
being conducted by various medical practitioners, a standardized medical examination format has been
developed by the Ministry of Health and Road Transport Department with input from clinical specialists,
the Malaysian Medical Association (MMA) and the Malaysian Institute of Road Safety Research (MIROS).
OBJECTIVE
The objective of this format is to :

. Ensure the standardization of medical examinations being conducted by the government
doctors and the private practitioners,
. To develop standards to be used in the determination of the fitness of the applicants
MEDICAL EXAMINATION
I. Who conducts the medical examinations?

. Government Doctors
Outpatient Doctors
Specialists (who have fulfilled the qualifying criteria); for applicants who are under their
follow up
. Private Practitioners
2. Place of examination
o Government Clinics
. Private Clinics
3. Examination Standards
The medical examination standards for vocational drivers licensing are to be used to
determine the fitness level of the applicants.
4, Confidentiality
. All information obtained from the medical examination is confidential and may not be
divulged to anyone without the permission of the applicant.
. All data of the medical examination will be retained by the clinic where the examination was
conducted.

MEDICAL IDXAMINATIONli'ORMAT
Part ^ : Applicants Information
This section describes the SOCio demographic details of the applicant and is to be coin leted b the
applicant.
The section includes:
I. Name of the applicant
11. Address
111. Identification card number
IV. Date of birth
v. Gender
i. Contact information
Vl.
Part 2 : Medical History
Medical history is to be completed by the applicant with the assistance of the medical
practitioner if necessary.
Declaration by the applicant
The applicant is to make a declaration on the accuracy of the information provided in Part 2 witnessed
by the examining doctor.
Part 3: Medical examination
A complete medical examination is to be conducted by the medical practitioner who is to enter the
findings obtained in Part 3.
a. General Examination
i. Weight
ii. Height
iii. Body Mass Index
iv, Date of Examination
b. Specific Examination
I. Vision
. Visual acquity is to be tested using Snellens Chart
. Visual field tested using the Confrontation Method
. Colour deficiency'tested using ishihara 'Charts

Confrontation Visual Field Test
indication To detect visual field defect

Tools Target: Finger or pen
Steps I. Explain to patient regarding the test.
2. Examiner sits I meter in front of the
patient.
3. Begin testing the patient's right eye by
asking the patient to close his/her left eye.
$1;^:<:r^?
~' , \,/ I
The examiner needs to close his/her right
eye.
'* I
4. Please asl< the patient to fixate at the
examiner's eye at all times during this test.
5. At SOCm or in between the patient and the I \
examiner, the examiner moves the target
from 180' temporal Iy towards the centre
until the patient could detect the target.
6. Repeat step 5 from all other directions,
including superior, .inferior, temporal and
nasal visual field.
7. Examiner must ensure the patient's eyes

are always fixated to the examiner's eye
during the entire test.
8. Repeat step 3 to 6 to test the left eye.
Result Normal visual field- Patient could detect the target
at all quadrants.
"' Hearing
o To be tested using the 'Whisper Test'
WHISPER TEST*
instructions
I. The examiner stands at arm's length (~0.6 in) behind the patient (to preventlip reading)
2. The opposite auditory canal is DCcluded by the patient or examiner and the tragus is rubbed in
a circular motion (goal; to block hearing from that ear)
3. The examiner exhales and whispers a combination of numbers and letters (example 4-K-
2). W/71^permg at the end of exhala!Ibn is to ensure as quiet and as standardized voice as
possible
4. if the patient responds correctly, hearing is considered normal and no further screening is
necessary on that ear.
5, if the patient responds incorrectly, then repeat using a different numberletter combination,
6, if on repeated testing, the patient can answer three out of a possible six numbers-letters
correctly, the patient passes. If they cannot answer three out of six or more, the patient fails in
that ear.
7, Repeat the sequence in the opposite ear using different combinations of numbers and letters.
(Note: patients with memory problems may need a simplified letter/number combination to
compensate for their inability to remember)
*Pirozzo S. Whispered voice test for screening for hearing impairment in adults and children:
systematic review. BMJ.
2003 October 25;327(7421):967.

Significance
Hearing loss prohibits patients from understanding conversations, contributes to cognitive
decline, and leads to social isolation. This impairment is the third most chronic impairment
among older people. it is also useful to ask the patient and family if they
have noticed any changes in hearing, to describe any changes and if they have had any prior
treatment.
Patients with no wax occlusion of their ear canal and who failed this test have a hearing loss
that correlates with 30 dB loss, This level of hearing loss has a significant affect on
communication.
iii. Neurology and Musculoskeletal

System This includes:
. History of epilepsy
. Symptoms of neurological disorders
. Conducting the Rhomberg's Test
. Examination of the Musculoskeletal System
iv. Cardiovascular System

. Blood pressure
. Pulse rate
. Apex Beat
. Heart sounds
v. Respiratory System
. Respiratory Sounds
Vl, Diabetes Mellitus

. A complete history of Diabetes Mellitus including treatment and attacks of
hypoglycaemia
Part 4 : Investigations
I. Blood investigations
11. HBAlc testing for applicants suffering from Diabetes Mellitus

Part 5 : Certification of fitness
i. Certification of fitness is to be completed by the examining doctor and indicates the

ability of the applicant to apply for a vocational driving license
ii. Information entered into the system during the examination will be registered and may
not be altered

PROCESS FLOW FOR THE APPLICANT
REGISTER AT THE CLINIC AND COMPLETE JPJL8A FORM FROM SECTION

A To SECTION F
..
.*
UNDERGO MEDICAL EXAMINATION
I
REFER BACK To RTD* FOR
APPROVAL OF LICENSE
*RTD: RQad Transport Department

PROC, 3SS inLow OF THE EXAMINING DOCTOR
REGISTER THE APPLICANT
'**,
WITNESS THE APPLICANT FILLING THE JPJ

L8A FORM FROM SECTION A To SECTION F
;!
,4!
CONDUCT MEDICAL EXAMINATION
"L
,.
*,
CERTIFICATION OF FITNESS OF
APPLICANT NEED To BE ENTERED REFER To RESPECTIVE DEPARTMENT
WITH THE DETAILS OF CLINIC AND IF NECESSARY
MEDICAL PRACTITIONER
4<-
^;,
41\.
CERTIFICATION OF FITNESS OF
APPLICANT NEED To BE ENTERED
WITH THE DETAILS OF CLINIC AND
MEDICAL PRACTITIONER

RlÎnlBRI1^1.1Cl^S
I. DUBois L. Clinical Skills for the Ophthalmic Examination: Basic Procedures, Second Edition.
SLACK Incorporated, 2006.
2. Guides to the Evaluation of Permanent Impairment - American Medical Association, Chicago,

5th edition 2000.
3, webmedia. unmc. edu/intmed/geriatrics/reynolds/pearlcards/functionaldisability

whisper_test. htm
4. en. wikipedia. org/wiki/Romberg's_test
5. Pro^Cal medicine, P. J. Mehta, twelfth edition, reprint 1997
6. A Guide To Physical Examination And History Taking By Barbara Bales

7. Respiratory Examination By Richard Rathehtt ://medinfo. onedLi/ earl/bcs/Glist/res .htmt

.
. ,,
.
. Tcl
**. I
t.
h'
~,
-I
,.

Penggunaan Borang Pemeriksaan Kesihatan (Jpjl8a) Baharu Bagi Permohonan Atau Pembahruan Lesen Vokasional - 20HB Ogos 2019

Uploaded by

Copyright:

Available Formats

You might also like

Penggunaan Borang Pemeriksaan Kesihatan (Jpjl8a) Baharu Bagi Permohonan Atau Pembahruan Lesen Vokasional - 20HB Ogos 2019

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Penggunaan Borang Pemeriksaan Kesihatan (Jpjl8a) Baharu Bagi Permohonan Atau Pembahruan Lesen Vokasional - 20HB Ogos 2019

Uploaded by

Copyright:

Available Formats

^:^ IBU PEJABAT I^;^

JABATAN PENGANGKUTAN JALAN MALAYSIA

PENGGUNAAN BORANG PEMERiKSAAN KESIHATAN (JPJL8A) BAHARU BAGl

2. Seperti yang sedia makium, prosedur pemeriksaan kesihatan bagi

3. Penggunaan borong pemeriksaan kesihatan dibahagikan kepada dua kategori

4. Bagi tujuan tersebut, satu jawatankuasa penilaian semula telah ditubuhkan

5. Hasil penilaian tersebut telah meinutuskan bahawa permohonan baharu atau

6. Mesyuarat penyelarasan yang melibatkan JPJ, KKM dan Malaysian Meatoa/

6.2. Penggunaan borong borang pemeriksaan kesihatan baharu (JPJL8A -

6.4. Bayaran pemeriksaan kesihatan yang dikenakan bagi setiap

6.6. Pihak JPJ dan KKM hendaklah me inbuat hebahan be inubung

6.7. Pihak MMA hendaklah meinbUat pemakluman dan hebahan kepada

7. Segala kernusykilan mengenai peKara jin hendaklah dirujuk kepada Bahagian

Sekian, terima kasih.

"BERKHIDMAT UNTUK NEGARA"

Saya yan en nkan am ariah,

(RIZAL Z I MAT RAWl)

Kernenterian Kesihatan Malaysia (KKM)

V. ~- ' ~ 124, Jalan Pahang,

YBhg. Dato' Sri Shaharuddin Khalid

YBrs. Tuan Zamakhshari Bin Hanipah

Tuan Shamsudin Bin Sharif

Puan Zahidah Binti Abd Jalil

Bahagian Logistik Dan Pengangkutan Daret

Bahagian Perancangan StrategiK dan Antarabangsa

(ill Gunakan HURUF BESAR

11ii) TandakanIdalam petak berkenaan

A. JENIS PERMOHONAN 1<ELAS LESEN DIPOHO

L. No. KP I Pasport I ategori

8. Ja, tjna Ulp)

,. Tarikh Luput 3, No. Lesen

Tarikh Luput Lesen No. Lencana

Vokasionat(inka ada) (jika adaj

Kelas Lesen Kod Kegunaan

Saya mengaku bahawa semua in aklumat yang dibenarkan adalah benar.

No. KIP ' ............,.........,.....,...,........,..,...................

E. MAI<LUMAT PEGAWAI PERUBATAN YANG BIASA MERAWAT :

(UNTUK DIPENUHI OLEH PENGAMAL PERUBATANj

Sita handakan X dalam ruang Yang bersesuaian 'Ya' at au 'Tidak'

8 Adakah pemohon me inpu ito n da tinggi Yang tidak

b. .......,.... ..,......... ...............,................. ............,.. .,....... ..,..,......... ......,........ ................................. ........

1.3 Pandangan-pandangan lain o1eh pengamal perubatan :

Cacatan : Kelewatan boleh berlaku kerana. diperlukan siasatan perubatan Ianjut.

Ta rida ta n ga n p emohon :... ..,... ... .....,...... ... ...,,....... ,..,... mm

it AYAKITIDAl< LAYAK SEMENTARAITIDAK LAVAK

Gunakan kod berlRut dan pillh satu sahaja. D , E , Ei. , E2

I. No. KP/ Pasport/ Polis/Tentera

- OrangAwam Malaysia 7 - Sill Kelahiran Malaysia

3, NO Lesen No. sin Lesen anda

BAHAGIAN E. MAKLUMAT PEGAWAI PERU8ATAN YANG BIASA MERAWAT:

BAHAGIAN F. PEMERIKSAAN PERUBATAN

i) SIIa baca panduan di inuka sebelah sebelum mengisi borang in I

I. No. KP I Pasport I Polls I Tentera 2, ori

5. POSkod I^. 6. Bandar

Hari Bulan Tahun

2. Ruangan in I Untuk Permohonan B u at nam an Kelas Lesen Vokasional Sahaja

Tarikh Luput Lesen No. Lencana 01ka ada)

Kelas Lesen Kod Kegunaan

I^11^:,,__.., Oat^,,, I:,,/ . g%^^=alla: Dale o1B!!all: _/ I