In-Field Digital Lensometer Repair Report
Customer Information (Service Location)
Company / Practice Name
Address (Onsite Geolocation)
ONSITE
Contact Name
Contact Phone
Contact Email
Field Service Reference
Work Order (WO) #
Sales Order # / Case #
Zoho #
Date & Time Onsite
Ophthalmic Field Service Technician
Unit Identification & Environment
Manufacturer
Model
Serial Number (S/N)
Location in Practice / Lab
Installation Type
Dedicated Lab Countertop
Dispensary Dispensing Desk
Pre-Test Instrument Table
Mobile Cart
Firmware / Software Version
Overall Physical Condition
Good
Fair
Poor / Damaged
Customer Reported Problem / Symptoms in Practice
On-Site Diagnostic Findings & Repair Actions
Technician Findings & Root Cause Analysis
Completed Field Service & Calibration Actions
Optical path, nosepiece aperture, and Hartmann sensor grid cleaned of dust/oil
Lens stop nosepiece ring inspected, microswitch contact and seat verified
Lens table slide guide tensioned, squared to 180° axis, and lubricated
Lens clamp / holder arm spring tension and silicone lens protector checked
3-dot marking pin assembly aligned, leveled, and ink cartridges refreshed
UV / Blue light transmittance sensor cleaned and baseline response zeroed
Internal thermal printer mechanism cleaned, paper track clear, test print passed
Zero-point initialization & power calibration verified with certified test lenses
Progressive addition (PAL) detection and near-zone addition tested
RS-232 / USB / LAN / Wi-Fi EMR communication verified to practice PMS
Final Site & Customer Close-out Actions
Equipment exterior wiped down and sanitized on-site
Defective parts, paper scraps, and packaging removed from customer workspace
Workstation counter area cleaned and vacuumed
Consulted with optical staff regarding lens positioning and nosepiece cleaning
Unit covered with protective dust cover upon service completion
Detailed Repair, Adjustment & Calibration Notes
On-Site Test Lens Calibration Verification
0.00 D Zero Offset Check
Test Lens -5.00 D Test
Test Lens +5.00 D Test
Cylinder / Axis Check
Prism Accuracy Check (Δ)
UV / Blue Light Transmittance
Parts & Consumables Replaced On-Site
Part / SKU #
Description
Qty
Action
✕
+ Add Replaced Part
Operational Verification & Final Status
Installed, Calibrated & 100% Functional for Dispensary / Lab Use
Yes — Fully Operational
No — Pending Follow-up
On-Site Signatures & Sign-off
Customer Approval: (Signature)
Clear Customer Signature
Customer Printed Name
Ophthalmic Field Service Technician: (Signature)
Clear Technician Signature
Technician Printed Name
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