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Vision Screening Test Result Form Screeners

The Vision Screening Test Result Form is used to document the results of vision screenings for students, including their names, ages, and whether they wear corrective glasses. It categorizes results into Front Row (FR) for those needing special seating and Not Front Row (NFR) for those who can sit anywhere. Recommendations for further evaluation by an eye care professional are provided based on the students' performance.

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Ana Acupeado
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952 views1 page

Vision Screening Test Result Form Screeners

The Vision Screening Test Result Form is used to document the results of vision screenings for students, including their names, ages, and whether they wear corrective glasses. It categorizes results into Front Row (FR) for those needing special seating and Not Front Row (NFR) for those who can sit anywhere. Recommendations for further evaluation by an eye care professional are provided based on the students' performance.

Uploaded by

Ana Acupeado
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Vision Screening Test Result Form

Name of School:
School Address: Date of Screening:
Teacher/Screener: Grade Level:
No. Corrective No. of Correct Result (FR/NFR)
Name of Student LRN Age Glasses Answers
Notes/
(Y/N) Right Left Right Left Eye Observation
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● FR (Front Row) Both Eyes: Not able to identify 3 of 5 figures for both eyes. Since both eyes have difficulty reading small letters, it is advisable to let the student sit in the front row to improve learning. S/he may
be referred to an eye care professional for evaluation.
● FR (Front Row) One Eye: Not able to identify 3 of 5 figures for one eye. Since only one eye has difficulty reading small letters, the student may be in the first 3 rows. However s/he needs to be seen by an eye
care professional for evaluation and possible screening for lazy eye.
● NFR (Not Front Row): Able to identify 3 of 5 figures. The student may be seated anywhere.

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