Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
DATA FORM
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Staff Name
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Date
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Shop
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Result
HYGIENE
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Result
MEASUREMENT
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Result
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SE
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Vertex Distance Compensation
EYE HEALTH CHECK
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Slit lamp Set up
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Lids & Lashes
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Purpose of lids and lashes
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Bulbar Conjunctiva
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Purpose of bulbar conjunctiva
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Palpebral Conjunctiva
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Purpose of palpebral conjunctiva
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Limbus
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Purpose of limbus
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Cornea
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Purpose of cornea
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Tears
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Purpose of tears
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Iris
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Purpose of iris
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Crystalline Lens
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Purpose of crystalline lens
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Over all Eye health procedure.
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Manners while processing on customers
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Using alcohol spray before touching customer.
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Compeletely write contact lens record
DISPENSING
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Insertion and Removal techniques
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Instruction for do and don't
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Appointment
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Recommend customer wear contact lens at least 4 hours before come to follow up after care
FITTING CHECK
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General
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Comfort
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Coverage
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Centration
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Lag-sag
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Movement
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Visual Acuity (V/A)
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Over – refraction
Checker comment
Signature
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Trainee
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Trainer
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Manager
