ESBD_510338_1777061233235_SOL_EXH_F.8_RC-11-Report of Vision Specialist Form Sample.pdf

This is a Report of Vision Specialist Form (RC-11, Revised 2/2014) used by the Texas Department of Public Safety for evaluating the vision qualifications of law enforcement officer applicants. The form documents the results of comprehensive eye examinations conducted by ophthalmologists or optometrists, including measurements of visual acuity for both eyes under uncorrected, corrected with glasses, and corrected with contacts conditions. The examination also includes field of vision assessments measuring peripheral vision to the right and left of the point of fixation, as well as color vision testing.

The form requires the examining ophthalmologist or optometrist to certify that the applicant has been personally examined, that examination results are within normal limits with no evidence of ocular disease, and that the applicant's vision will not hinder their performance as a law enforcement officer. The certification section requires the examiner's signature, business address, and phone number. The form includes both the examiner's assessment and a separate DPS examiner section with pass/fail recommendation, approval or disapproval determination, examiner name, date, and designated space for comments regarding the applicant's vision fitness for law enforcement duties.