Visual prototype. Nothing entered on this form is saved or transmitted.
DJ
De Jesus Platform Works Vision Examination Portal
DW
D. Whitfield · Examiner
Examiner

New annual vision examination

Record near-vision and color-vision results for each eye, then capture both signatures before submitting for Level III review.

Scan authorization or badge

Handheld scanner

Scan the employer authorization the employee brought, or their badge. The scanner types into this field like a keyboard — no driver or setup needed.

Try AUTH-2026-00148 or RAS-40912
Inspector
Starts on the company's standard. The pass rule below follows it.
For example, the customer contract specifies EN 4179. Logged on the record and flagged for the Level III Examiner.
Shown for NDT levels only.
Used when no NDT certification level applies.
Near vision — Jaeger

Record the smallest line read.

Right eye (OD)

Not recorded
Correction used

Left eye (OS)

Not recorded
Correction used

Near vision result

Not recorded
Color vision — Ishihara
Color-vision outcome
Signatures
Inspector signature
Click or tap to sign
Rasheed Okafor Not yet signed
Examiner signature
Click or tap to sign
Dana Whitfield Not yet signed

Examination details

Employer authorization

Optional

A signed paper authorization may be attached at any point in the workflow.

Select a scanned authorization
No file selected

Submit

Submitting sends the record to the assigned Level III Examiner for review.