Emergency Hours of Service Exemption Request Form
Submit your request for an emergency exemption from hours of service requirements. Please provide accurate and complete information to expedite review.
Full Name
*
First Name
Last Name
Company or Organization
*
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Position or Title
Type of Emergency
*
Please Select
Natural Disaster
Public Health Emergency
Supply Chain Disruption
Other
Describe the Emergency Situation
*
Requested Exemption Start Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Requested Exemption End Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Vehicle or Operation Details
Submit Request
Should be Empty: