Eye Examination - Hdkbr
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1EXAMPLE OF CERTIFICATE OF EYE EXAMINATION
(requirements pursuant to item 6.4 of HRN EN 473 standard and item7.2 of ISO 9712
standard)
EYE EXAMINATION
Personal Information
I.
Name:
Surname:
OIB:
Place and date of birth:
Address:
Zip code and city:
Test result
II.
Farsightedness enables reading of at least first row on Jaeger eye chart or N4.5 of
a)
Times Roman or equivalent sign (height – 1,6 mm) at the distance not shorter than 30
cm for at least one eye:
without corrective measures
with corrective measures
satisfactory
unsatisfactory
b) Ability to recognise and distinguish contrasts between colours or between shades of
grey (depends on the non-destructive testing method which a person uses):
colour
shades of grey
satisfactory
satisfactory
Place and date of issue:
Doctor:
Health institution:
Institution seal
Seal, signature
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Parent category: Medical