Introduction to this document

Display screen equipment (DSE) eye test form

Whilst you don’t need to openly advertise the fact that you’re obliged to pay for an eye test, if requested to do so, it’s best to be prepared. So why not use our DSE eye test form to give to an optician?

DSE eye tests

Whilst the DSE regulations require you to pay for an eye test, you don’t need to openly advertise this fact on your notice boards. Instead, a couple of lines in your DSE policy will be enough. However, should staff ask for a test, you may find it useful to have a Display Screen Equipment (DSE) Eye Test Form to give them to take to the optician.

Eye test authorisation

The first part of the form (A) contains space for you to insert employee details. This is used so only those who meet the eligibility requirements of the legislation can obtain free eye tests. To try to avoid confusion, the form then sets out the legal position with regards to exactly what employees are entitled to, e.g. glasses solely for use with DSE equipment.

For optician’s use

The second part (B) contains a section for the optician to fill in. This asks them to tick a box to confirm the frequency of eye tests and whether glasses are necessary for DSE use. There’s also room for them to sign and date the form and stamp it.