(1) Verification. School bus drivers must provide verification to their employer of passing a medical examination completed by a medical examiner at or prior to the current certificate expiration date.

(2) Exemptions or waivers. If the medical examiner determines the school bus driver does not meet the minimum federal medical standards for interstate commerce but qualifies for an interstate exemption, the school bus driver must comply with the Federal Motor Carrier Safety Administration's exemption program. If the medical examiner determines the school bus driver does not meet the minimum federal medical standards for intrastate commerce, but qualifies for an intrastate medical waiver, the school bus driver must comply with the department of licensing's requirements for an intrastate medical waiver as defined in WAC 480-30-226. School bus drivers must provide their employer a copy of their valid federal exemption or intrastate medical waiver certificate.

(3) Continued requirement. School bus drivers must continue to meet these medical requirements during the time between examinations.

(4) Medical examinations required by local education agencies.

(a) A local education agency may require more frequent examinations of any school bus driver.

(b) If a local education agency requires a school bus driver to be examined by a local agency selected physician, the local education agency must pay for the cost of such exam. If the driver objects to the local education agency's selected physician, a physician must be selected that is mutually acceptable.

(5) Individuals with diabetes. An individual who is a diabetic being treated with insulin may hold a school bus driver authorization if they meet the following requirements:

(a) Possess a medical examiner's certificate showing the driver is qualified and meets the medical requirements defined in WAC 392-144-020(14); or

(b) Possess a valid commercial driver license intrastate medical waiver certificate for diabetes from the Washington state department of licensing;

(c) Provide at a minimum of every twenty-four months to the authorizing local education agency(ies) or employer a completed, signed copy of Form SPI 1643 (Part A), Application Section, and a completed, signed copy of Form SPI 1643 (Part B), Physician Evaluation Section indicating the driver's medical condition allows them to safely operate a school bus while using insulin. The physician evaluation section must indicate that within the past three years, the driver has completed instruction including diabetes management and driving safety; the signs and symptoms of hypoglycemia and hyperglycemia, and what procedures must be followed if complications arise. Physician verification of participation in a diabetes education program covering these topics is required at least every three years in order to remain qualified for a school bus driver authorization;

(d) Provide at a minimum of every twelve months to the authorizing local education agency(ies) or employer a completed, signed copy of Form SPI 1643 (Part C), Vision Evaluation Section indicating the driver does not have any vision problems that might impair safe driving;

(e) Provide at a minimum of every six months to the authorizing local education agency(ies) or employer a completed, signed copy of Form SPI 1643 (Part D), HbA1c Report Section indicating values more than 5.9 and less than 9.6 (unless accompanied by the signed medical opinion that the event was incidental and not an indication of failure to control glucose levels);

(f) Self-monitor blood glucose using an FDA approved device and demonstrate conformance with requirements (more than 100 mg/dl and less than 300 mg/dl):

(i) Within one hour before driving vehicles transporting students; and

(ii) Approximately every four hours while on duty.

(g) Maintain a daily log of all glucose test results for the previous six-month period and provide copies to the authorizing local education agency(ies) or employer, and the medical examiner or physician upon request;

(h) Carry a source of readily absorbable/fast-acting glucose while on duty;

(i) Report immediately to their employer, any failure to comply with specific glucose level requirements as listed in (e) or (f) of this subsection, or loss of consciousness or control;

(j) Individuals who have had a loss of consciousness or loss of control (cognitive function) due to a diabetic event do not qualify for a school bus driver authorization for one year, provided there has not been a recurrent hypoglycemic reaction requiring assistance of another person within the previous five years;

(k) A school bus driver is no longer authorized to operate a school bus and must be immediately removed from driving duties for any of the following:

(i) Results of the most recent HbA1c test indicating values less than 6.0 or greater than 9.5 (unless accompanied by the signed medical opinion that the event was incidental and not an indication of failure to control glucose levels);

(ii) Results of self-monitoring indicate glucose levels less than 100 mg/dl or greater than 300 mg/dl, until self-monitoring indicates compliance with specifications;

(iii) Experiencing a loss of consciousness or control relating to diabetic condition;

(iv) Failing to maintain or falsifying the required records, including self-monitoring records and any section of Form SPI 1643.

(l) The authorizing local education agency or employer may request medical review of any or all signed, completed sections of Form SPI 1643 (Parts A-D), Washington state authorized school bus driver diabetes exemption program, and the driver's daily glucose test logs by a medical examiner or physician of their choice. The cost of this review shall be paid by the local education agency or employer.