VISION TEST REPORT FORM FOR NON-DESTRUCTIVE TESTING PERSONNEL

PROTECTED (When Complete)

NRCan National NDT Certification Body (NDTCB)8.2.1-003 Vision Test Report Form for Non-Destructive Testing Personnel

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Published 2017-02-14Page 1 of 1

This form must be completed and submitted to the Natural Resources Canada (NRCan) National Non-Destructive Testing Certification Body (NDTCB) when applying for initial certification, certification renewal and recertification in any NDT method. Completed Vision Test Report Forms are valid for a period of one year (12 months). Incomplete documentation may lead to longer processing times.

Three visual acuity tests may be required:1. Near Vision Acuity2. Distance Vision Acuity (required for Visual Testing method applications only)3. Colour VisionPlease note: If you are applying for initial certification, certification renewal or recertification in the Visual Testing (VT) method the Distance Vision Acuity Test must be completed; if it is not completed the application for Visual Testing (VT) will not be accepted.

Examiner’s Name (Please print) Examiner’s Signature

Examiner’s Appointment/Title (Please print)Date of Vision Test: //

YYYY MM DD

3. Colour Vision:

Please note: A candidate who passes an Ishihara Test is acceptable. As an alternative to or in case of a failure of an Ishihara Test, the employer or an NRCan/CGSB-certified Level 3 NDT personnel may administer a performance test to confirm if the candidate can see flaw indications that are typical of the method. For example: In liquid penetrant, confirm that the candidate can see red indications on a white background and fluorescent-green indications on a variety of backgrounds.

Colour vision tests must be completed, signed for, and dated by medically recognized personnel (E.g., opthamologist, optometrist,physician, registered nurse, etc.), the candidate’s employer, or an NRCan/CGSB-certified Level 3 NDT personnel.Colour vision shall be sufficient that the candidate can distinguish and differentiate contrast between the colours or shades ofgrey used in the NDT method concerned, as specified by the employer.

I confirm that the candidate (Please check one box only):Meets the requirement Does not meet the requirement

Registration #:Candidate’s Name:

1. Near Vision Acuity:

Near Vision Acuity and Distance Vision Acuity:Both near and distance visual acuity tests must be completed, signed for, and dated by medically recognized personnel (E.g., opthamologist, optometrist, physician, registered nurse, etc.).

Near vision acuity shall permit reading a minimum ofJaeger number 1 or Times Roman N 4.5 or equivalentletters (having a height of 1,6 mm) at not less than 30 cmwith one or both eyes, either corrected or uncorrected.

2. Distance Vision Acuity (required for VT method):Distance vision acuity shall equal Snellen Fraction 20/30or better with one or both eyes, either corrected oruncorrected.

I confirm that the candidate (Please check one box only):Meets the requirement without correction Meets the requirement with correctionDoes not meet the requirement

Meets the requirement without correction Meets the requirement with correctionDoes not meet the requirement

Examiner’s Name (Please print) Examiner’s Signature

Examiner’s Appointment/Title (Please print)Date of Vision Test: /

DD/

MMYYYY

I confirm that the candidate (Please check one box only):Not applicable: candidate is not applying for VT

Candidate’s Signature: Date: /DD

/MMYYYY