VISION CERTIFICATE

This is to certify that _________________________________ was tested for the following:

NEAR VISION
The above named person was tested on Near Vision with Jaegers Chart at a distance not less than 12 inches
(30.5 cm) and found to be satisfactory / unsatisfactory in reading the following Jaeger Number.

Left

: J1 / J2

without Correction

with Correction

Right : J1 / J2

without Correction

with Correction

COLOUR PERCEPTION
The above named person was tested on Color Perception with Ishihara Chart, shades of grey and found
to be
Satisfactory

Unsatisfactory

Remarks:-

Date Examined

Next Examination Date

______________

____________________

Examined By
______________