/ EYESIGHT TEST CERTIFICATE
Marine Safety (Domestic Commercial Vessel) National Law Act 2012, Schedule 1

The results of this eyesight examination will be used by the National Regulator to form an opinion whetherthe candidate’s eyesight meets the standards required by the National Regulator for the issue of a deck or engineering Certificate of Competency.

A. Candidate information

Full name of candidateContact phone number

Address of candidate

Level of Marine Certificate of Competency applied for

I, of

(Name of MP or Optometrist)(Address)

being a duly qualified Doctor/Optometrist hereby certify that I tested the above candidate on

(Date)

and identified him/her by the following method: passport drivers licence personally known to me

B. Results of examination

1Letter Test (Snellen Principle)

Without using any aids to visionWith aids to vision (if applicable)

Right eye / Left eye / Right eye / Left eye

1aDeck certificates requirement

  • Minimum acceptable is 6/6 in the better eye and 6/9 in the other (with or without aids).
  • If aids are used to meet the 6/6 and 6/9 requirement, then the minimum acceptable is
    6/60 in each eyewithout aids.

Has the deck requirement been met?YesNo

1bEngineering certificates requirement

  • Minimum acceptable is 6/9 in both eyes (with or without aids).
  • If aids are used to meet the 6/6 and 6/9 requirement, then the minimumacceptable is
    6/60 in each eye without aids.

Has the engineering requirement been met?YesNo

2Near vision requirement

Read N5 chart at 300mm – 500mm with or without aids

Has the near vision requirement been met?

  • With aidsYesNo
  • Without aidsYesNo

3Were aids to vision used to achieve minimum and near vision requirements?YesNo

4Colour vision requirement

  • Has the applicant passed the ISHIHARA Test with or without aids to vision? ORYesNo
  • Has the applicant passed the Holmes-Wright Lantern Test Type B with or without aids to vision?YesNo

C. Declaration by Medical Practitioner/Optometrist

I, declare that the candidate has / has notmetthe eyesight test requirements listed above.

I certify that I have examined ,date of birth:

(Applicant’s name)

Address:

Identified by means of:

(drivers licence, passport etc)

I declare that:

  • to the best of my knowledge the information provided by me in this application (and any attachments I have included with this application) is true and correct.
  • I understand and acknowledge that a person is guilty of an offence under section 137.1 of the Criminal Code Act 1995 if the person gives false or misleading information, or omits anything without which the information is misleading to a Commonwealth entity; a person who is exercising powers or performing functions under a law of the Commonwealth, or the information is given in compliance or purported compliance with a law of the Commonwealth.

Signature of Doctor/Optometrist:

Name of Doctor/Optometrist:

Address:

Date of Examination:

Privacy Statement
The purpose of collecting this information is to allow the National Regulator to decide whether to issue a Certificate of Competency under s. 60(1) of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012. This information may be passed to Commonwealth or State/Territory government agencies for the purposes of marine safety.

Notes

General

  • The term “aids to vision” means glasses or contact lenses which have been prescribed by a qualified optometrist or eye specialist to correct a person’s eyesight.
  • Monocular Vision (Deck and Engine crew) - for an applicant who has vision in only 1 eye, the applicant does not have to meet the standard that applies to the other eye; and the certificate must include a statement that the applicant meets the standard with monocular vision only.
  • Coxswain certificates of competency should be considered as a deck certificate for the purpose of this standard.
  • Eyesight and colour vision testing is not required for renewal of a certificate for General Purpose Hand NC, Coxswain Grade 2 NC, Coxswain Grade 1 NC, Master <24m NC, Marine Engine Driver Grade 3 NC or Marine Engine Driver Grade 2NC, (or GPH, Coxswain, Master 5,Skipper 3, MED 3, MED 2) candidates, unless any changes to vision affecting ability to perform duties are noted on the Declaration of Medical Fitness.

Colour Vision

  • A colour-corrective lens cannot be used in a colour-vision test.
  • The Ishihara test shall be conducted using all 24 plates. In order to pass, a candidate must correctly identify at least 13 of the first 15 plates in the 24-plate version. The only optical aids permitted to be used for colour vision testing areprescribed lenses worn by an applicant for the acuity test. An applicant may not use tinted glasses or tinted contact lenses.
  • Where an applicant fails the Ishihara colour vision test, he/she may be re-examined with the Holmes-Wright lantern
    test type “B” or the Marine Orders colour matching test for Marine Engine Driver Grade 1NC and Engineer 3NC candidates.
  • In the case of applicants Master <24m NC, Master (Inland Waters), Coxswain Grade 1 NC, Coxswain Grade 2 NC the National Regulator or the delegate of the National Regulator may, in lieu of the above requirements, accept a statement from a suitably qualified optometrist, eye specialist or medical practitioner, that after having examined the applicant, the applicant suffers no greater abnormality in colour-vision than could be tested by the Ishihara Test.
  • Colour vision testing is not required for General Purpose Hand NC, Marine Engine Driver Grade 3 NC or Marine Engine Driver Grade 2 NC(or General Purpose Hand, MED 3, MED 2).

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