Operation KidSight
Spot Vision Screener
Documents
As of January
8, 2015 Version 2 of the HSB OKS Operations Manual is now available. This will
replace Version 1 which was released on August 26, 2014. The major changes are a
result of acquiring 15 more Spots thanks to the LCIF grant we received. We now
have an online reservation system for each Zone that has a HSB Spot to make it
easy to see what dates are available and to request specific dates for
screenings. There were minor changes to many of the forms with a major change
to the Spot Transfer Form. This form
allows the transfer of a Spot form between a Zone Coordinator to a club or a
transfer between two clubs. It is
recommended you download the PDF of the new manual and a zip file of the forms
so you can start using them. You can do that by clicking on the following:
OKS Program
Overview from training event on January 10, 2015
Once you have
downloaded all the forms you can at a later date download a single form below.
1.
Club Planning Template - A template that
each club can use as a starting point to create their own yearly vision
screening plan. The template is in Microsoft Word format with links to online
resources to (e.g. NH schools and Daycare Centers)
2.
Vision Screening
Important for Young Children - Vision Screening overview to be used when meeting with Site Coordinators (e.g.
School Nurses and Daycare Directors)
1.
Consent Form – Every child
screened needs to have a Consent Form is signed by their parent/guardian. This
is customizable by each club to include name of club, screening date and
contact information.
2.
Screening Results
Letter Option A
- Letter to be distributed to parents along with the printout of the screening
results. One letter covers either a referral or no referral.
3.
Screening Results
Letter Option B
- Letter that can be customized to add local Optometrists and Ophthalmologists.
4.
Vision Screening
Summary
- Samples of screening results from the Spot - one for Screening
Complete, Complete Eye Exam Recommended and Screening
Flagged
5.
USB Drive
Instructions
- An instruction sheet for Site Coordinators on how to load the USB drive with
the children to be screened.
6.
Manual Screening
Sheet
- Used to keep track of people screened when the USB
drive approach is not able to be used. Primarily used for Public and Other
Events.
7.
NH Background Check - Background Checks
using State of NH forms
8.
Spot Usage Transfer
Form
- This is an agreement between two entities (OKS Zone Coordinator and/or Club)
on the transfer of the Spot Kit. This form includes a checklist of all the
items contained in the Spot Kit and verification everything is in working
order.
1.
Screening Event
Checklist
– A one page summary of the key steps needing to be done for a Screening Event.
2.
Screening Event
Summary 44N
- A summary of the screening event with the # of children screened, # referred,
event, club, etc. that will be sent to the District
3.
Screening Event
Summary 44H
- A summary of the screening event with the # of children screened, # referred,
event, club, etc. that will be sent to the District
4.
Lions Coloring Page - A file that can be
printed and handed out as a reward for children that have been screened.
Thank You Letter - Letter to Site Coordinators
thanking them for arranging the screening(s), reminding them of following up on
referrals.
NH
Background Check Instructions