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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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What is the best visual acuity ever recorded?

All applicants must pass an eye examination, with or without corrective lenses, to prove near vision acuity on Jaeger J2 at 12 in. or greater (30.5 cm). All applicants shall take a color perception test.

How to document visual acuity results?

The first number indicates the distance of the patient from the chart, and the second indicates the distance at which a normal eye can read that line of letters. For example, visual acuity of 20/50 means that at 20 feet the patient can read print that a person with normal vision could read at 50 feet.

How do you record visual acuity findings?

The visual acuity should be recorded as uncorrected (without glasses or contact lenses) and corrected (with glasses or contact lenses) visual acuity. The results of visual acuity tests are usually noted with V, VA, or Va.

How to record a visual acuity test?

20/40 +2 indicates that the individual was able to read all of the 20/40 line and 2 letters on the next smaller line. Many individuals with visual impairments require reduced observation distance and the practitioner should be aware that changing observation distance can influence the acuity score obtained.