CL Checklist OWNDAYS TH

• 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

PRODUCT INFORMATION

Information of color contact lens

• Product price of color contact lens

  Pass

  Fail

• Series and color

  Pass

  Fail

• Water content (42%)

  Pass

  Fail

• Diameter

  Pass

  Fail

• Wearing schedules

  Pass

  Fail

• Thickness (0.08mm)

  Pass

  Fail

• Material (Hema)

  Pass

  Fail

• Power range

  Pass

  Fail

• DK (11.3)

  Pass

  Fail

Information of clear contact lens

• Product price of clear contact lens

  Pass

  Fail

• Water content (38%)

  Pass

  Fail

• Diameter

  Pass

  Fail

• Wearing schedules

  Pass

  Fail

• Thickness (0.06mm)

  Pass

  Fail

• Material (Polymacon)

  Pass

  Fail

• Power range

  Pass

  Fail

• DK (13.5)

  Pass

  Fail

• Key features of Color contact lens

  Select Embedded color pigment Tri-curve edge Fail

  • Embedded color pigment
  • Tri-curve edge
  • Fail

• Key features of Clear contact lens

  Select Natural moisturizing UV Protection Comfort care Fail

  • Natural moisturizing
  • UV Protection
  • Comfort care
  • Fail

• Contact lens care

  Good

  Fair

  Poor

• Instruction for do and don't

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

Signature

• Trainee

  Sign

• Trainer

  Sign

• Manager

  Sign