Get Vsp Video Display Terminal Confirmation Form - Csusm

Filling out the VSP Video Display Terminal Confirmation Form online can streamline the process of obtaining your supplemental VDT benefit. This guide provides clear, step-by-step instructions to help you navigate each section of the form efficiently.

Follow the steps to complete the form online accurately.

1. Click the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering your full name in the format 'Last Name, First Name'. Ensure that this matches your official records for accurate processing.
3. Indicate your gender by selecting either 'Male' or 'Female'.
4. Fill in your street address, followed by your city, state, and zip code.
5. Provide the last four digits of your social security number to verify your identity.
6. Input your date of birth for further identification.
7. Record the average hours you spend at the video display terminal (VDT) each day.
8. Describe your work environment, focusing on the lighting conditions present in your workspace.
9. List your job title for context regarding your VDT use.
10. Check all symptoms you experience while using the VDT, including headaches, vision issues, and eye strain.
11. Indicate whether you use glasses or contacts while working at the VDT and note if you reference materials during your work.
12. Measure and fill in the viewing distances between your eyes and the VDT screen, keyboard, and reference materials.
13. Specify the relative height of the VDT screen and reference materials compared to eye level.
14. Read and confirm the statement regarding your job requirements and eligibility for the VDT benefit, signing and dating the form at the end.
15. Finally, ensure to save your changes, then download, print, or share the completed form as needed.

Complete your VSP Video Display Terminal Confirmation Form online to secure your benefits today.