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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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