In the bustling city of New York, where the skyline is continually reshaped by the hands of skilled workers, the LIC 60 form plays a pivotal role in ensuring the safety and meticulous craftsmanship that define the city's infrastructure. This Visual Acuity Examination Form is a crucial requirement for both aspiring and current welders seeking to obtain or renew their welding license. It embodies the city's commitment to maintaining high standards of workmanship by mandating that all welders possess the necessary visual acuity, with or without corrective lenses, to perform their tasks with precision. Administered by a qualified professional such as an Ophthalmologist, Optometrist, Medical Doctor, Registered Nurse, or Certified Physician’s Assistant, the form validates an applicant's near vision acuity to Jaeger J2 standards at no less than 12 inches away. Only with this verification, which ensures a welder's ability to see details at close range, can an application for a welding license be considered complete. The Department of Buildings stands firm in its refusal to accept incomplete forms or results that fall short of its stringent visual fitness requirements. Through such measures, New York City ensures that its iconic structures and invaluable public works are crafted by individuals whose abilities are not just proven by their technical skills but also by their physical capability to meet the demands of this challenging profession.
| Question | Answer |
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| Form Name | Nyc Form Lic 60 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | lic60 visual acuity jaeger j2 pdf form |
VISUAL ACUITY EXAMINATION FORM
Instructions
Applicants: This form must be submitted for all welder original and renewal applications.
Be sure to keep a copy of this form for your records. Your application for an original or renewal license will not be accepted unless a completed Visual Acuity Examination Form is submitted.
The examination must occur and this form must be completed 1 year (12 months) prior to the date of application for an original or renewal welder license. One of the following is required to administer the eye examination: Ophthalmologist, Optometrist, Medical Doctor, Registered Nurse or Certified Physician’s Assistant.
All applicants must pass an eye examination, with or without corrective lenses, to prove near vision acuity on Jaeger J2 at 12 inches or greater (≥30.5 cm). Examination results must be documented on this form and submitted with your appli- cation.
The Department of Buildings will not accept forms that are incomplete or test results that do not comply with fitness requirements.
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Applicant/ Licensee Information
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Original Welder License |
Renewal Welder License |
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First Name |
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Last Name |
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License # |
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THE FOLLOWING TWO SECTIONS ARE TO BE COMPLETED BY THE EYE EXAMINER
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Vision Acuity
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Please verify the applicant’s near vision acuity to Jaeger J2 specifications at a distance of |
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12 inches or greater (≥30.5 cm): (please check one of the following) |
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Both eyes require corrected vision to J2 |
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Only one eye needs corrected vision to J2 |
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No correction is required. |
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Examiner
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Applicants Name |
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Date of Eye Examination |
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Examiner Name |
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Telephone Number |
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Examiner Address |
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City |
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Zip |
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Examiner Professional Status (please select only one) : |
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Ophthalmologist |
Optometrist |
Medical Doctor |
Registered Nurse |
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Certified Physician’s Assistant |
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Examiner Signature |
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and Stamp (If |
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State/Prov. |
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Stamp is Available) |
______________________________ Date |
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License # |
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LIC 60 12/11