1st Grade Practical test [Slit lamp]

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

EYE HEALTH CHECK

Hygiene

• Over all

  Pass

  Fail

• Using alcohol spray before touching customer

  Pass

  Fail

• Slit lamp Set up

  Pass

  Fail

• Lids & Lashes

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Bulbar Conjunctiva

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Palpebral Conjunctiva

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Limbus

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Iris

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Cornea

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Tears

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Crystalline Lens

  Select Slit width Brightness Magnification Angle Identify Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Identify
  • Fail

• Manners while processing on customers

  Pass

  Fail

FITTING CHECK

• Comfort

  Pass

  Fail

• Coverage

  Select Slit width Brightness Magnification Angle Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Evaluation
  • Fail

• Centration

  Select Slit width Brightness Magnification Angle Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Evaluation
  • Fail

Lag-Sag

• Primary gaze

  Select Slit width Brightness Magnification Angle Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Evaluation
  • Fail

• Up gaze

  Select Slit width Brightness Magnification Angle Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Evaluation
  • Fail

• Lateral gaze

  Select Slit width Brightness Magnification Angle Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Evaluation
  • Fail

• Movement

  Select Slit width Brightness Magnification Angle Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Angle
  • Evaluation
  • Fail

Signature

• Trainee

  Sign

• Trainer

  Sign

• Manager

  Sign