In-Field Slit Lamp 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
Slit Lamp Identification & Lane Environment
Manufacturer
Model
Serial Number (S/N)
Exam Lane / Room #
Mounting Configuration
Instrument Stand Arm Mount
Motorized Table Mount
Wheelchair Accessible Table
Direct Tabletop Mount
Illumination System
Tower Style (Upper Illumination)
Base Style (Lower Illumination)
LED Integrated
Halogen
Overall Physical Condition
Good
Fair
Poor / Damaged
Customer Reported Problem / Symptoms in Lane
On-Site Diagnostic Findings & Repair Actions
Technician Findings & Root Cause Analysis
Completed Field Service & Reconditioning Actions
Optics cleaned and inspected (eyepieces, magnification drum, objective lens)
Mechanical analog functions rebuilt / adjusted (slit width, slit height, aperture rotation)
Electrical wiring, power transformer, rheostat, and cable connectors serviced
Light intensity verified and bulb / LED housing aligned
Cross-slide table rails de-greased, re-lubricated, and gear track play adjusted
Joystick vertical drive, micro-switch, and multi-directional glide tensioned
Slit Lamp table mount / instrument stand arm leveled and locked
Focusing rod calibration pass across all magnification steps (parfocality verified)
Cabling secured, strain-relieved, and concealed in arm / table tracks
Final Site & Customer Close-out Actions
Equipment wiped down and sanitized on-site
Defective parts, shipping boxes, and packing material removed from customer lane
Exam area cleaned and vacuumed around base / stand
Consulted with customer / doctor regarding accessories and ergonomic placement
Slit Lamp covered with dust cover upon service completion
Detailed Repair, Adjustment & Calibration Notes
Parts & Consumables Replaced On-Site
Part / SKU #
Description
Qty
Action
✕
+ Add Replaced Part
Operational Verification & Final Status
Installed & 100% Functional for Patient Care
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
Generate & Download Field Repair Report