Vision screening- tracking.xlsx

	A	B	D	E	F	G	H	I	J	K	L	M
2	Tier 1 vision screening		Number of students screened:
3	(Use a separate registration sheet per class)		Number of students referred:
4
5	School:				Date/ time:
6	Screening site:				Teacher:
7		Passing line:			Examiner:
8
9		Student's name	Grade	Wears glasses	Visual acuity chart						Referred	Notes
10		Student's name	Grade	Wears glasses	Right pass/refer	Left pass/refer	Right	Left	2 line difference	SPOT pass/refer	Referred	Notes
11	1.				P R	P R	20/	20/		P R
12	2.				P R	P R	20/	20/		P R
13	3.				P R	P R	20/	20/		P R
14	4.				P R	P R	20/	20/		P R
15	5.				P R	P R	20/	20/		P R
16	6.				P R	P R	20/	20/		P R
17	7.				P R	P R	20/	20/		P R
18	8.				P R	P R	20/	20/		P R
19	9.				P R	P R	20/	20/		P R
20	10.				P R	P R	20/	20/		P R
21	11.				P R	P R	20/	20/		P R
22	12.				P R	P R	20/	20/		P R
23	13.				P R	P R	20/	20/		P R
24	14.				P R	P R	20/	20/		P R
25	15.				P R	P R	20/	20/		P R
26	16.				P R	P R	20/	20/		P R
27	17.				P R	P R	20/	20/		P R
28	18.				P R	P R	20/	20/		P R
29	19.				P R	P R	20/	20/		P R
30	20.				P R	P R	20/	20/		P R
31	21.				P R	P R	20/	20/		P R
32	22.				P R	P R	20/	20/		P R
33	23.				P R	P R	20/	20/		P R
34	24.				P R	P R	20/	20/		P R
35	25.				P R	P R	20/	20/		P R
36	26.				P R	P R	20/	20/		P R
37	27.				P R	P R	20/	20/		P R
38	28.				P R	P R	20/	20/		P R
39	29.				P R	P R	20/	20/		P R
40	30.				P R	P R	20/	20/		P R
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