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Form 1 Opticians Report Completed

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rayshorne939
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79 views3 pages

Form 1 Opticians Report Completed

Uploaded by

rayshorne939
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Version Feb 22 This form is only required if you are not using eyecareplans.co.uk Candidate Name: Rayshorne Stewart uRN: SA SS65)0L Navy Command Official Sensitive Personal (When Completed) Optician Report Form Date of Birth: Ob Dowmbe- 1.000 BOP: Engin@esing Technician (Marine Engineering) The person presenting this form has applied to j in the Royal Navy and is required to meet certain eyesight standards. Please record their visual measurements on the form below as accurately as possible. Please use the Visual Acuity Standards detailed overleaf to grade the candidate. ‘Measurement Right Eye Left Eye Distance Unaided (pse annotate worse than/better than/equal to) fe “fo Distance Aided (pse annotate worse than/better than/equal to) “So Se Near Unaided aye 7G Near Aided oe - Sphere o00 0.00 Cylinder —o0350 —a:58 | Axis 10s ee Additional Comment Version Feb 22 Official Sensitive Personal (When Completed) Official Sensitive Personal (When Completed) Visual Acuity Standards Standard | Right Eye Left Eye Visual acuity to be achieved 6i2NS eae Ne without correcting lenses Visual acuity to be achieved 616 NS 616 NS with correcting lenses Refraction limit Total hypermetropia +3.00 sphere +3,00 sphere Astigmatism 41.28 cyl 41.25 cyl Myopia (in any meridian) -0.75 sphere or oy! -0.75 sphere or cyl ‘Standard 2 Visual acuity to be achieved without correcting lenses e160 >6/60 Visual acuity to be achieved with correcting lenses 616 NS 6/9 NS Refraction limit, Cylindrical error greater than +3,00 or -3.00 diotres in any meridian. Spectacle correction (in any +5.00/-6,00 sphere or cyl -+5.00/-6.00 sphere or meridian) using ESE Calculation oyl ‘Standard 3 Visual acuity to be achieved 6/60 >6/60 «without correcting lenses Visual acuity to be achieved Either 6/6 NS 624.NIO with correcting lenses or 6/9 NS 6/18 NIO or 6/12 NS 6/12 N10 Refraction limit Cylindrical error greater than +3.00 or -3.00 diotres in any meridian. Spectacle correction (in any +5.00/- 6.00 sphere or +5,00/-6,00 sphere or meridian) using ESE Calculation cylinder cylinder Please tick the appropriate box statement, confirm in the box below, sign, date, stamp and place in a sealed envelope before handing it back to the individual immediately after the examinatior V7 ]__|confirm that the individual | have examined, with reference to the guidance above DOES meet Visual Standard 1, 2, or 3. | confirm that the individual | have examined DOES NOT meet the Visual Standards for entry to the Royal Navy and is below VA3. Entitled to Free Eye Test ves L] No (U16/U19 in FTE) Confirm Visual Standard below (PLEASE TICK APPROPRIATE BOX BELOW) Version Feb 22 vAt va2 VA3 Below VA3 Official Stamp: Fie, 6 0 kay 2 RUSSELL’ BUILDING MED Official Sensitive Personal ‘When Completed) REY-GROUND 784 5508769 784 4545027

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