Contact lens staff checklist

• Contact lens staff checklist

  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

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Lids & Lashes

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Bulbar Conjunctiva

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Palpebral Conjunctiva

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Limbus

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Iris

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Cornea

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Tears

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Crystalline Lens

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

• Manners while processing on customers

  Pass

  Fail

FITTING CHECK

• Comfort <br>

  Pass

  Fail

• Coverage

  Select Slit width Brightness Magnification Type of illuminations Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Evaluation
  • Fail

• Centration

  Select Slit width Brightness Magnification Type of illuminations Identifify Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Identifify
  • Fail

Lag-sag

• Primary gaze

  Select Slit width Brightness Magnification Type of illuminations Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Evaluation
  • Fail

• Up gazeำ

  Select Slit width Brightness Magnification Type of illuminations Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Evaluation
  • Fail

• Lateral gaze

  Select Slit width Brightness Magnification Type of illuminations Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Evaluation
  • Fail

• Movement

  Select Slit width Brightness Magnification Type of illuminations Evaluation Fail

  • Slit width
  • Brightness
  • Magnification
  • Type of illuminations
  • Evaluation
  • Fail

PRODUCT INFORMATION

• Product price [Color contact lens / Clear contact lens]

  Pass

  Fail

Information of color contact lens

• Base curve of contact lens

  Pass

  Fail

• Water content

  Pass

  Fail

• DIA

  Pass

  Fail

• Wearing schedules

  Pass

  Fail

• Thickness

  Pass

  Fail

• Material

  Pass

  Fail

• power range

  Pass

  Fail

• DK

  Pass

  Fail

Information of clear contact lens

• Series and color of color contact lens

  Pass

  Fail

• Base curve of contact lens

  Pass

  Fail

• Water content

  Pass

  Fail

• DIA

  Pass

  Fail

• Wearing schedules

  Pass

  Fail

• Thickness

  Pass

  Fail

• Material

  Pass

  Fail

• power range

  Pass

  Fail

• DK

  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 6 5 4 3 2 1

  • 6
  • 5
  • 4
  • 3
  • 2
  • 1

Signature

• Trainee

  Sign

• Trainer

  Sign

• Manager

  Sign