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INSPECTOR VISUAL ACUITY RECORD 2026
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- Click ‘Get Form’ to open the INSPECTOR VISUAL ACUITY RECORD in the editor.
- Begin by entering your name and inspector number at the top of the form. This identifies you as the candidate for the eye examination.
- Fill in the date of the examination, along with your address and contact information, including both home and work telephone numbers.
- Provide your email address for any follow-up communication regarding your certification.
- In the TEST RESULTS section, input your name and the date of your eye exam. Indicate whether you possess near vision acuity of Jaeger J2 at a distance of 12–17 inches, selecting 'Yes' or 'Yes, but with corrective lenses'.
- Answer questions regarding color perception and differentiation between red and green by selecting 'Yes' or 'No'.
- Select your professional level from the provided options and fill in your eye examiner's details, including their name, state license number, professional address, and contact number.
- Finally, ensure that the eye examiner signs and dates the form to certify that they administered your examination.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2003 | 4.6 Satisfied (60 Votes) |
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