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Vision Test Form

This document outlines vision requirements for personnel conducting visual testing according to SNT-TC-1A. It specifies that annual near vision and color contrast differentiation examinations are required, with the near vision exam ensuring the ability to read Jaeger number 2 font at 12 inches or greater. The color contrast exam must demonstrate the ability to distinguish colors used in the employer's method. Vision exams expire on the last day of the expiration month. Exams must be done by approved medical professionals and documented using the provided form, including employer attestation for any color deficiencies.

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Rameez Farouk
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2K views1 page

Vision Test Form

This document outlines vision requirements for personnel conducting visual testing according to SNT-TC-1A. It specifies that annual near vision and color contrast differentiation examinations are required, with the near vision exam ensuring the ability to read Jaeger number 2 font at 12 inches or greater. The color contrast exam must demonstrate the ability to distinguish colors used in the employer's method. Vision exams expire on the last day of the expiration month. Exams must be done by approved medical professionals and documented using the provided form, including employer attestation for any color deficiencies.

Uploaded by

Rameez Farouk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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1.

Vision Requirements (As per SNT-TC-1A)


a. Near Vision Acuity. The examination should ensure natural or corrected near-distance acuity in at least one eye
such that the applicant is capable of reading a minimum of Jaeger Number 2 or equivalent type and size letter at
the distance designated on the chart but not less than 12 in. (30.5 cm) on a standard Jaeger test chart. The ability
to perceive an Ortho-Rater minimum of 8 or similar test pattern is also acceptable. This should be administered
annually.
b. Color Contrast Differentiation. The examination should demonstrate the capability of distinguishing and
differentiating contrast among colors or shades of grey used in the method as determined by the employer. This
should be conducted upon initial certification and at five-year intervals thereafter.
c. Vision examination expires on the last day of the month of expiration.

Vision examinations shall be administrated by a Physician, Licensed Nurse, Ophthalmologist or Optometrist or by


personnel approved by the employer’s Level III. The form below may be used for documentation.

_______________________________________________________________________________________
2. Attestation of Visual Acuity
Eye Exam Date: ___________________ (dd/mmm/yyyy)
Candidate Name (please print): ___________________________________________
I attest that I administered a near distance examination on the candidate named above, and that the candidate
has natural or corrected near-distance acuity in at least one eye capable of reading the Jaeger Number 1 test
chart or equivalent at a distance of not less than 30.5 cm (12 in).
I attest that I administered a color perception examination on the candidate named above and that the candidate
has:

☐ No Color Perception Deficiency ☐Color Perception Deficiency (Specify) ______________________

_____________________ ______________________
Signature of eye examiner Date (dd/mmm/yyyy)

☐Ophthalmologist/Optometrist ☐Physician ☐Registered Nurse

☐Employer’s Level III Certificate No.:____________ Expiration date: _____________

☐Other (Approved by the Employer’s Level III): Title: ____________________________

_______________________________________________________________________________________
3. Employer Attestation (for Candidate Color Perception Deficiency)
If the candidate has a color perception deficiency, the candidate’s ability to distinguish colors used in the
applicable method(s) as specified by the employer must be confirmed by the employer or a designated and
responsible agent of the employer (such as an ASNT Level III, ACCP Professional Level III, or company Level
III per SNT-TC-1A).
I attest that the above named candidate has sufficiently demonstrated the ability to distinguish colors used in the
applicable test method(s) as specified in employer procedures.

__________________________ _____________________
Employer/Agent Signature Date (dd/mmm/yyyy)
____________________________ _______________________
Employer/Agent Name (print) ASNT ID (if applicable)
____________________________
Title

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