Form 46 - Recruiting Section Vision Examination Of Applicant

Form 46 - Recruiting Section Vision Examination Of Applicant - Delta Police

RECRUITING SECTION

Vision Examination of Applicant

4455 Clarence Taylor Crescent . Delta . BC V4K 3E1 . Phone: 604.946.4411

deltapolice.ca

Applicant: ______________________________________ Date of Examination:

Delta Police Department vision standards for employment are as follows:

Distant vision:

Minimum for those not requiring visual aid:

1 )

2 0 /20 be tter e ye

2 )

2 0 /30 poo r e r e ye

Minimum for those requiring visual aid:

Unaided: 20/60 in each eye or 20/40 better eye, 20/100 poorer eye

Aided: 20/20 better eye, 20/30 poorer eye

Horizontal vision:

Normal, not less than 120° each eye, examined separately

Binocular vision:

Normal

Color vision:

Must have 12 or more of 1-15 plates correct (Ishihara test)

Examination of Applicant by Ophthalmologist/Optometrist

Eye(s)

Uncorrected

Corrected

Right:

Left:

Both:

Horizontal vision:

Right eye:

Left eye: __________________________

Binocular vision: ________________________________ Color vision: __________________________

Has the applicant had laser surgery? ________ If yes, date of surgery: ________________________

Note: Radial keratotomy is not an accepted procedure

Meets standards:

Yes _____

No _____

Comments:

Ophthalmologist/Optometrist:

Name: ___________________________________ Signature: __________________________________

Address:

Phone: _____________________________

Delta Police Department – Vision Examination of Applicant

Rev. 13.08 – Form 46

Form 46 - Recruiting Section Vision Examination Of Applicant - Delta Police

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