Form DLD-49 template
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Certificate of visual examination
The document is a Certificate of Visual Examination for a Utah driver. It includes sections for reporting medical conditions relevant to driving and public safety, the stability of the driver's visual condition, and comments from a vision health care professional. The form requires completion by both the driver and a vision health care professional, with fraudulent submission resulting in criminal and administrative action. The form asks about the need for corrective lenses while driving, the driver's visual acuity, and their visual field. For CDL drivers, questions are asked about color blindness and visual fields less than 120 degrees. Recommendations for review times and restrictions are also included.
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