Print Name of Person who Performed the above Date of Test: LO \ 6 | 4 Test: Signature of Tester: Profession please tick: Optometrist (] Medical Doctor ae Registered Nurse Certified to ISO 9712 Level 3 [] Other (please specify) C] Eyesight tests provided by’ opticians/hospitals etc. will be accepted as long as they clearly state that all of the requirements have been met. If needed or for guidance please use this TWI CL Eye Test Form. Any observed difficulty during the eye test should be reported to the employer. CSWIP/10YR/2019