TWICL Eye Sight Test form Name of individual tested | ANWAR MOHIUDDIN Date Of Birth | 22-02-1983 Address KING SALMAN INTERNATIONAL CONVENTION CENTER, MADINAH - KSA | | To comply with certification requirements, all CSWIP & BGAS-CSWIP Certificate holders are required to submit results of an eye test taken within the last 2 years. All CSWIP NDT (1509712) Certificate holders will need to submit results of an eye test taken within 1 year. ALL CSWIP & BGAS-CSWIP CERTIFICATE HOLDERS MUST TAKE A NEAR VISION TEST: 's the above named person capable of reading Times Roman N4.S or Jaeger 1 on a standard reading test plate at a distance of no lessthan 30cm unaided or corrected in at least one eye? CAN READ UNCORRECTED CAN READ WITH CORRECTION [] ISNOT ABLE [] All BGAS-CSWIP & CSWIP NDT Certificate holders must also provide the results of a colour perception test. Colour perception shall be assessed by the wr 24 plate test. Colour Perception Test: Satisfactory Unsatisfactory ] Radiographic Interpretation, Radiographic Inspector & TOFD certificate holders are also required to-complete a Shades of Grey Perception Test. Shades of Grey Perception: Satisfactory WY Unsatisfactory [] DETAILS OF PERSON PERFORMING THE ABOVE TEST. Dateoftest: 2.2, 5/23 Print Name of Person who Performed the ab semwestnse: (Ht ALAA 1 ohne diy Emboss/official stamp here: Profession please tick: Optometrist . Nena 1 90 fe anaes aaa Registered Nurse [] Su.) 488-445, Optihalmologat Certified to ISO 9712 Level3. [] manson) Other medically recognised person (please specify their qualification) [] (Please note that tests carried out by ASNT certificate holders will not be accepted) 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 eeded or for guidance please use this TWI CL Eye Test Form. Any observed difficulty during the eye test should be reported to the employer. Page 8 of 8 cswip/os/10vR/2023