Contact Lens OWNDAYS THAILAND (Checklist)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Staff Name

• Date

  Date

• Shop

• Result

  Pass

  Fail

  N/A

HYGIENE

• Result

  Pass

  Fail

  N/A

MEASUREMENT

• Result

  Pass

  Fail

  N/A

• SE

  Pass

  Fail

  N/A

• Vertex Distance Compensation

  Pass

  Fail

  N/A

EYE HEALTH CHECK

• Slit lamp Set up

  Pass

  Fail

  N/A

• Lids & Lashes

  Pass

  Fail

  N/A

• Purpose of lids and lashes

  Pass

  Fail

  N/A

• Bulbar Conjunctiva

  Pass

  Fail

  N/A

• Purpose of bulbar conjunctiva

  Pass

  Fail

  N/A

• Palpebral Conjunctiva

  Pass

  Fail

  N/A

• Purpose of palpebral conjunctiva

  Pass

  Fail

  N/A

• Limbus

  Pass

  Fail

  N/A

• Purpose of limbus

  Pass

  Fail

  N/A

• Cornea

  Pass

  Fail

  N/A

• Purpose of cornea

  Pass

  Fail

  N/A

• Tears

  Pass

  Fail

  N/A

• Purpose of tears

  Pass

  Fail

  N/A

• Iris

  Pass

  Fail

  N/A

• Purpose of iris

  Pass

  Fail

  N/A

• Crystalline Lens

  Pass

  Fail

  N/A

• Purpose of crystalline lens

  Pass

  Fail

  N/A

• Over all Eye health procedure.

  Pass

  Fail

  N/A

• Manners while processing on customers

  Pass

  Fail

  N/A

• Using alcohol spray before touching customer.

  Pass

  Fail

  N/A

• Compeletely write contact lens record

  Pass

  Fail

  N/A

DISPENSING

• Insertion and Removal techniques

  Pass

  Fail

  N/A

• Instruction for do and don't

  Pass

  Fail

  N/A

• Appointment

  Pass

  Fail

  N/A

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

  Pass

  Fail

  N/A

FITTING CHECK

• General

  Pass

  Fail

  N/A

• Comfort

  Pass

  Fail

  N/A

• Coverage

  Pass

  Fail

  N/A

• Centration

  Pass

  Fail

  N/A

• Lag-sag

  Pass

  Fail

  N/A

• Movement

  Pass

  Fail

  N/A

• Visual Acuity (V/A)

  Pass

  Fail

  N/A

• Over – refraction

  Pass

  Fail

  N/A

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