Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

DATA FORM

  • Staff Name

  • Date

  • Shop

  • Result

HYGIENE

  • Result

MEASUREMENT

  • Result

  • SE

  • Vertex Distance Compensation

EYE HEALTH CHECK

  • Slit lamp Set up

  • Lids & Lashes

  • Purpose of lids and lashes

  • Bulbar Conjunctiva

  • Purpose of bulbar conjunctiva

  • Palpebral Conjunctiva

  • Purpose of palpebral conjunctiva

  • Limbus

  • Purpose of limbus

  • Cornea

  • Purpose of cornea

  • Tears

  • Purpose of tears

  • Iris

  • Purpose of iris

  • Crystalline Lens

  • Purpose of crystalline lens

  • Over all Eye health procedure.

  • Manners while processing on customers

  • Using alcohol spray before touching customer.

  • Compeletely write contact lens record

DISPENSING

  • Insertion and Removal techniques

  • Instruction for do and don't

  • Appointment

  • Recommend customer wear contact lens at least 4 hours before come to follow up after care

FITTING CHECK

  • General

  • Comfort

  • Coverage

  • Centration

  • Lag-sag

  • Movement

  • Visual Acuity (V/A)

  • Over – refraction

Checker comment

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.