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Oregon WCD Form 2312: Visual Impairment Report

Oregon examiners report work-related visual impairment on this one-page WCD form, revised in April 2026 with Bulletin 239. It records best-corrected distance and near acuity for each eye, lens status, visual field loss, diplopia, glare, monocular diplopia, stereopsis and tearing problems that affect regular work. The insurer or the Workers' Compensation Division uses the findings to rate permanent impairment.

Who completes it

The examining ophthalmologist, optometrist or attending physician performing the closing exam completes the whole form and prints name and title, signs and dates it.

Submitting and payment

How to submit it
Return it with the examination report to the insurer or self-insured employer.
Who pays
The insurer pays the lesser of the billed amount or the OAR 436-009-0040 physician fee schedule amount, and the worker cannot be billed for an accepted claim.

Good to know

  • All visual loss is measured with best correction, using the lenses the worker's physician recommends; for distance acuity below 20/400, report whether the worker can count fingers at four feet.
  • Measure each visual field separately by kinetic perimetry with a III/4e stimulus, reported on an eight-meridian chart to 90 degrees or a monocular Esterman grid.
  • The April 2026 revision dropped the Goldmann perimeter as the required device, following OAR 436-035-0260(3) effective April 1, 2026.
  • Mark glare, monocular diplopia and stereopsis as mild, moderate or severe, and grade tearing problems by how much regular work they prevent.

Get the official form

Download the current version from the source each time; forms change without notice.

Visual Impairment

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Which version of Oregon Form 2312 should I use?

Use the version stamped 440-2312 (4/26). WCD republished Bulletin 239 on April 9, 2026 specifically to issue a revised Form 2312 and update its visual field section, removing the Goldmann perimeter requirement in favor of the device requirements in OAR 436-035-0260(3).

How is near vision reported on Form 2312?

Report near vision for each eye in Snellen 14/14 notation, Revised Jaeger Standard or American point-type units, and distance vision in standard Snellen increments. The form also asks whether each eye has a natural lens, an implanted prosthetic lens or aphakia.