10至10块以上辨色板合格不合格□□□灰色影阴检查
10 or More PlatesAcceptedUnacceptedColor Vision and
9至9块以下辨色板合格不合格Shade of Gray□□□9 or Less PlatesAcceptedUnacceptedTest
能识别20个以上灰度等级Over 20合格不合格□□□shades of gray chart can be discerned.AcceptedUnaccepted解释结果此视力检查结果已对我解释受检人签字
视力检查记录表
Vision Examination Record
编号No.：
受检人
The Examinee姓名
Name
职务
Title工号
Number
部门
Department
□J-2离眼睛12英寸（305毫米）Held 12in. (305mm) from the Eyes.裸眼
Natural
矫正
Corrected右眼
ResultsThe results of this visual acuity test have beenExaminee
Explainedexplained to me.Signature
检查日期下次检验日期
Examination Date of Next Examination
评语(假如无评语请写上“无”)
检验部门签字职务Examined bySignatureTitle
表格编号Form No.：
QC-***
□合格AcceptedNatural
矫正
□不合格UnacceptedCorrected
离辨色板725mmHeld plate 7பைடு நூலகம்5mm from the individual tilted so that the其平面与视线成90oplane of the plate is at right angles to the line of vision.色盲和
Right Eye左眼
Left Eye双眼
Both Eyes结果Results□合格Accepted近距离视力
□不合格Unaccepted耶格视力表检查
Near Vision
□J-2离眼睛17英寸（430毫米）Held 17in. (430mm) from the Eyes.Jaeger Test
右眼左眼双眼结果Right EyeLeft EyeBoth EyesResults裸眼