Date post: | 15-Apr-2017 |
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Record of Diver’s Vision Test Name: ID number: Contact Detail:
Result of Near Vision Test
Record of smallest text capable of being read by individual:
Corrected Uncorrected Left: Right:
Left: Right:
PASS / FAIL Pass criteria: Corrected or uncorrected near vision acuity permitting reading of N4.5 Times Roman at a minimum distance of 30cm in at least one eye, according to CSWIP-DIV-7-95-Part 1, paragraph 1.2. Acceptable alternative criteria are Jeager 1, Jeager 2 or Snellen 0.6
Approved eye examiner: Signed: Date of test:
Certificate not valid without stamp