Official (Closed) , Sensitive (High)

Colour Vision Test Form

CONFIDENTIAL

COLOUR VISION TEST FORM (2020) This form may take you 2 minutes to complete. The information provided will be kept strictly confidential and will be used only for the purpose of assessing fitness for course admission.

PART A – TO BE COMPLETED BY STUDENT Full Name: Admission Number:

Contact Number:

(Mobile) (Home) NRIC / Passport / FIN:

The Colour Vision Test is only applicable to students who have been offered the following courses. Please tick () the course that you have been offered:

Aeronautical Engineering

Aerospace Electronics

Applied Chemistry

Biomedical Science

Chemical Engineering

Common Engineering Programme

Electrical & Electronic Engineering

Food Science & Technology

Marine Engineering

PART B – TO BE COMPLETED BY THE EXAMINING DOCTOR (REGISTERED IN SINGAPORE) I certify that the above-named has undergone the Colour Vision (Ishihara Test) and the result is as follows: Tick () 1 only Normal

Partial: Red / Green deficiency

Complete: Red / Green deficiency

Remarks (if any): _________________________________________________________________________________

Name of Doctor: Signature of Doctor:

Name & Address of Clinic (Clinic’s Official Stamp): Date:

Please return the completed form to: Admissions Office, Singapore Polytechnic, 500 Dover Road, Singapore 139651

INSTRUCTIONS TO STUDENTSStudents would need to complete Part A of the Colour Vision Test Form and bring it to any medical practitioner registered in Singapore withtheir NRIC / Passport:

Students may visit a private clinic or their family doctor. Once students have received the completed Colour Vision Test Form fromtheir doctor, they would need to submit it to Singapore Polytechnic (SP) via ONE of the following ways:o Submit it personally at SP One Stop Centre (Blk T16, Level 1); ORo Post it to SP Admissions Office, Singapore Polytechnic, 500 Dover Road, Singapore 139651.Alternatively, students may visit any of the SATA CommHealth clinics listed on this page. The clinic will submit the completed ColourVision Test Form to SP directly.

Bespectacled students are required to bring their pair of glasses for the Colour Vision Test.The Colour Vision Test fees will be borne by the students.Students with “Partial Colour Vision Deficiency” or “Complete Colour Vision Deficiency” result for their Colour Vision Test may encounterdifficulties in meeting the requirements and expectations for the courses they have been offered. These students would need to email toSP Admissions Office at contactus@sp.edu.sg immediately so that SP may try to arrange for a course transfer. Students should includethe following information in their email:

Email Subject: Colour Vision DeficiencyStudent’s full name and SP Admission Number;The name of the course that was initially offered to him / her; andIndicate either “Partial Colour Vision Deficiency” or “Complete Colour Vision Deficiency”.

Students who have questions on the Colour Vision Test can call SP on 6775-1133 during office hours (Monday to Friday, 8.30am to 5.30pm).

SATA CommHealth Colour Vision Test fees (for Singapore Citizens / Permanent Residents): S$16.05 (inclusive of 7% GST) Students may experience a longer waiting time during the peak timings. It is advisable to avoid the weekends.

SATA CommHealth Enquiry Hotline: 6244-6688 (www.sata.com.sg)8.00 am to 5.30 pm (Monday to Friday) 8.00 am to 1.30 pm (Saturday)

Clinic Address & Location Clinic Operating Hours* (Closed on Public Holidays)

Ang Mo Kio Medical Centre715 Ang Mo Kio Ave 6 #01-4008 / 4010 Singapore 560715Bus Interchange: Ang Mo Kio InterchangeMRT Station: Ang Mo Kio

Monday to Friday: 8.30 am to 5.00 pmNight Clinic (Monday to Friday): 6.00 pm to 9.00 pm Saturday: 8.30 am to 1.00 pm

Boon Lay Medical Centre500 Corporation Road #01-01NKF Integrated Renal Centre Singapore 649808Bus Service: 240, 246MRT Station: Lakeside

Monday to Friday: 8.30 am to 12.00 pm, 1.00 pm to 5.00 pm 12.00 pm to 1.00 pm - closed for lunchSaturday: 8.30 am to 1.00 pmNo Audiometry Services

Jurong Medical Centre135 Jurong Gateway Road #04-345 Singapore 600135Bus Service: 51, 66, 78, 79, 97, 98, 105, 197MRT Station: Jurong East

Monday to Friday: 8.30 am to 5.00 pmSaturday: 8.30 am to 1.00 pm

Potong Pasir Medical Centre1 Siang Kuang Avenue Singapore 347919Bus Service: 8, 61, 64, 65, 66, 90, 125, 151, 154After Tai Thong Cres, Macpherson Rd) 13, 107, 107M, 133, 142,

147, 853, 853C (Opp Leong Bee Crt, Upp Serangoon Rd)MRT Station: Potong Pasir

Monday to Friday: 8.30 am to 12.00 pm, 1.00 pm to 5.00 pm 12.00 pm to 1.00 pm - closed for lunchSaturday and Sunday: 8.30 am to 1.00 pm

Tampines Medical Centre5 Tampines Central 6 #01-01A Telepark Building Singapore 529482Bus Service: Tampines InterchangeMRT Station: Tampines

Monday to Friday: 8.30 am to 12.00 pm, 1.00 pm to 5.00 pm 12.00 pm to 1.00 pm - closed for lunchSaturday: 8.30 am to 1.00 pmNo Mammogram & Audiometry Services

Tanjong Pagar Clinic7 Tanjong Pagar Plaza #02-103 Singapore 081007Bus Service: 80,145MRT Station: Tanjong Pagar

Monday to Friday: 8.30 am to 12.00 pm, 1.00 pm to 5.00 pm 12.00 pm to 1.00 pm - closed for lunchSaturday: 8.30 am to 1.00 pmNo Mammogram & Audiometry Services

Uttamram (Bedok) Medical Centre 351 Chai Chee Street Singapore 468982 Bus Service: 26, 222MRT Station: Bedok

Monday to Friday: 8.30 am to 5.00 pm Saturday: 8.30 am to 1.00 pm FREE parking

Woodlands Medical Centre900 South Woodlands Drive #04-01 Woodlands Civic Centre Singapore 730900Bus Interchange: Woodlands Regional Bus InterchangeMRT Station: Woodlands

Monday to Friday: 8.30 am to 5.00 pm Saturday: 8.30 am to 1.00 pm

*Weekend & Night Clinic surcharges of $6.42 (inclusive of GST) are waived for SP students.8.30am to 12.30pm (Business day) on Eve of Christmas Day, New Year Day & Chinese New Year.