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    Examen Visual

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    Jorge Vera
    The document provides instructions for completing a visual acuity record form, which must be submitted by applicants for welding inspector or radiographic interpreter certification to verify that the applicant meets minimum vision requirements. Applicants must pass a near vision acuity test and color perception test conducted by a medical professional within 7 months prior to an exam. The visual acuity record form collects information about the applicant's vision test results and the examining medical professional.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Examen Visual

    Uploaded by

    Jorge Vera
    138 views1 page
    The document provides instructions for completing a visual acuity record form, which must be submitted by applicants for welding inspector or radiographic interpreter certification to verify that the applicant meets minimum vision requirements. Applicants must pass a near vision acuity test and color perception test conducted by a medical professional within 7 months prior to an exam. The visual acuity record form collects information about the applicant's vision test results and the examining medical professional.

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    examen visual

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    The document provides instructions for completing a visual acuity record form, which must be submitted by applicants for welding inspector or radiographic interpreter certification to verify that the applicant meets minimum vision requirements. Applicants must pass a near vision acuity test and color perception test conducted by a medical professional within 7 months prior to an exam. The visual acuity record form collects information about the applicant's vision test results and the examining medical professional.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    138 views1 page

    Examen Visual

    Uploaded by

    Jorge Vera
    The document provides instructions for completing a visual acuity record form, which must be submitted by applicants for welding inspector or radiographic interpreter certification to verify that the applicant meets minimum vision requirements. Applicants must pass a near vision acuity test and color perception test conducted by a medical professional within 7 months prior to an exam. The visual acuity record form collects information about the applicant's vision test results and the examining medical professional.

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    © All Rights Reserved
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    of 1

    550 NW LeJeune Rd Miami, Fl 33126

    VISUAL ACUITY RECORD


    (800) 443-9353 or (305) 443-9353, ext. 273
    FAXED APPLICATIONS ARE NOT ACCEPTED

    LAST NAME : _______________________________________________ Certification # (if applicable) : ______________________

    FIRST NAME : _______________________________________________ MEMBER # (if applicable) : ______________________

    If scheduled to take an AWS certification exam, site location: ________________________________Date___________________

    TO APPLICANTS:
    This form must be submitted for all Welding Inspector and Radiographic Interpreter applications. Applicants for the Certified Welding
    Educator only are not required to complete this form.

    Before submitting this form with your application to AWS, be sure to keep a copy for your records. If youre unable to supply a
    completed Visual Acuity Record with your application prior to a submission deadline, you may forward this form to the Certification
    Department separately. Exam applicants may submit completed Visual Acuity Records on exam day. AWS will not release exam
    results and/or certification renewal without a completed Visual Acuity Record on file.

    You must use the services of an Ophthalmologist, Optometrist, Medical Doctor, Registered Nurse or Certified Physicians Assistant to
    administer your required eye examination. The examination must occur within the seven months prior to the scheduled date of the
    applicants examination and/or certification expiration date.

    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. Eye examination results must be documented on this visual acuity
    form supplied by the AWS Certification Department. No other forms will be accepted.

    AWS will not accept visual acuity test results that are incomplete or do not comply with regulations.

    THE FOLLOWING THREE SECTIONS ARE TO BE COMPLETED BY THE EYE EXAMINER

    1. Please verify the customers close vision acuity to Jaeger J2 specifications at a distance of 12 inches AWS
    or greater (30.5 cm): (please check one of the following) use only

    Both eyes require corrected vision to J2 W


    Only one eye needs corrected vision to J2 W
    No correction is required. O

    AWS
    2. Through a color perception examination, is the applicant colorblind? (please check one of the following) use only

    No, customer is not colorblind C


    Yes, customer is colorblind. B

    3. PLEASE PRINT CLEARLY

    CUSTOMER NAME: _____________________________________________ DATE OF EYE EXAMINATION: ______________________

    EXAMINER NAME: ______________________________________________TELEPHONE NUMBER: ( ) ________-___________

    EXAMINER ADDRESS: _________________________________________________________________________________________

    CITY: ____________________________________ ST/PROVINCE: _____________ ZIP: _____________COUNTRY: _____________


    EXAMINER PROFESSIONAL STATUS BY (please check only one):
    Ophthalmologist Optometrist Medical Doctor Registered Nurse Certified Physicians Assistant

    EXAMINER SIGNATURE: _____________________________________ STATE/PROV. LICENSE NUMBER: ______________________

    Cert-Visual Acuity Record (1638.doc) 6/25/07

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