Ophthalmic Installation Checklist
Customer Information
Company / Practice Name
Address
ONSITE
Contact Name
Contact Phone
Contact Email
Reference
Sales Order #
Work Order (WO) #
Zoho #
Date & Time
Ophthalmic Field Service Technician
Select Equipment to Install
Examination Chair
Instrument Stand
Slit Lamp
Applanation Tonometer
Non-Contact Tonometer (NCT)
Automated Perimeter / Visual Field
Manual Phoropter
Digital Phoropter
AutoRefractor / Keratometer
Keratometer (Manual)
Manual Lensometer
Digital Lensometer
Hand Held Scopes
Acuity Chart / Projector
Binocular Indirect (BIO)
Trial Frame
Trial Lens Set
Indirect Ophthalmoscope
Examination Chair
+ Add Another Chair
Room:
Manufacturer
Essilor
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Motor (recline/incline/up/down)
Rotation lock & foot brake operation
Mechanical functions (arm rests, headrest, foot rest)
Electrical (wires, connections, footswitch, membrane switch)
Upholstery condition & inspection
Final Site Actions
Equipment is clean and wiped down
Cleaned area with vacuum after install
Boxes and packing material have been removed
Installed and functional
Yes
No
Instrument Stand
+ Add Another Stand
Room:
Manufacturer
Essilor
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Mechanical & counterbalance counter-tensioning
Electrical console, charging wells & transformer connections
Overhead Lamp & dimmer rheostat operation
Leveled and locked phoropter arm
Leveled and locked Slit Lamp arm
Slit Lamp safety limit switch operational
Checked lubrication to all pivot mechanisms
Final Site Actions
Wiped dust off chassis and arms
Cleaned area with vacuum after install
Boxes and packing material have been removed
Installed and functional
Yes
No
Slit Lamp
+ Add Another Slit Lamp
Room:
Manufacturer
Essilor
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Optics clean (eyepieces, magnification drum, objectives)
Mechanical (slit width/height, aperture rotation, joystick elevation)
Electrical (wires, connections, power supply)
Light Intensity & bulb/LED alignment
Secured and concealed cabling
Leveled SL table / arm mount
Covered SL after installation
Final Site Actions
Boxes and packing material have been removed
Consulted with customer regarding accessories placement
Clean area with vacuum after install
Installed and functional
Yes
No
Applanation Tonometer
+ Add Another Applanation Tonometer
Room:
Manufacturer
Essilor
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Calibration weight verification pass (0, 2, 6 g)
Mechanical arm swing and measuring drum smooth
Verified optical alignment with Slit Lamp objective
Measuring prisms inspected (clean / crack-free)
Final Site Actions
Cleaned exterior of tonometer
Boxes and packing material removed
Clean area with vacuum after install
Installed and functional
Yes
No
Non-Contact Tonometer (NCT)
+ Add Another NCT
Room:
Manufacturer
Essilor
Reichert
Topcon
Nidek
Keeler
Model
Instrument S/N
Motorized Table S/N
Condition
New
Good
Fair
Poor
Inspection
Pneumatic air-puff nozzle clean & pressure pulse self-test pass
3D Auto-alignment, auto-tracking & pupil fixation target operational
Optical sensor window and applanation detector free of debris
Motorized chinrest travel smooth & forehead rest secure
Internal thermal printer functional (paper loaded & clean printout)
Data transfer / serial interface / EMR export connection verified
Final Site Actions
Chinrest sanitized and optical chassis wiped clean
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Automated Perimeter / Visual Field
+ Add Another Perimeter
Room:
Manufacturer
Essilor
Optopol (PTS)
Zeiss (HFA)
Haag-Streit (Octopus)
Oculus (Easyfield/Twinfield)
Model
Perimeter S/N
Motorized Table S/N
Condition
New
Good
Fair
Poor
Inspection
Bowl background luminance & optical stimulus projection calibrated
Gaze tracking camera & pupil alignment monitor verified
Patient response button / clicker continuity check pass
Motorized chinrest / forehead rest alignment smooth
Software database initialization, normative data & baseline test pass
DICOM / EMR network export & report printer validated
Final Site Actions
Perimeter bowl & exterior wiped clean with lint-free cloth
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Manual Phoropter
+ Add Another Manual Phoropter
Room:
Manufacturer
Essilor
Reichert
Marco
Topcon
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Mounting arm leveling bubble calibrated & zeroed
Sphere & Cylinder power dials smooth (no gear binding/slipping)
Jackson Cross-Cylinder rotation & alignment detents smooth
Rotary prisms & auxiliary lens turrets indexed correctly
PD adjustment dial & convergence levers smooth and accurate
Internal and external viewing aperture optics clean
Near point reading rod and test card attached
Final Site Actions
Exterior wiped down and sanitized
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Digital Phoropter
+ Add Another Digital Phoropter
Room:
Manufacturer
Essilor
Topcon
Nidek
Reichert
Model
Optical Head S/N
Console / Tablet S/N
Software Version
Condition
New
Good
Fair
Poor
Inspection
Optical head motor self-test, homing & lens drum initialization pass
Controller console / wireless tablet paired and responsive
PD motors and convergence positioning calibrated
Acuity chart / screen synchronization & polarization verified
EMR / EHR data transfer protocol configured and tested
Power supply, table harness & communication cabling strain-relieved
Final Site Actions
Wiped and sanitized optical head and console
Dust cover placed & customer trained on daily power down
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
AutoRefractor / Keratometer
+ Add Another AutoRefractor
Room:
Manufacturer
Essilor
Topcon
Nidek
Reichert
Canon
Model
Instrument S/N
Motorized Table S/N
Condition
New
Good
Fair
Poor
Inspection
Model eye calibration / reading accuracy verified
3D Auto-tracking, auto-alignment & auto-shoot operational
Joystick elevation / glide mechanism smooth & locking knob holds
Motorized chinrest up/down travel & canthus marker aligned
Internal thermal printer functional (paper loaded & clean printout)
Data export / RS-232 / LAN / EMR link to phoropter or PC verified
Measurement objective window clean and free of dust / smudges
Final Site Actions
Forehead rest & chinrest sanitized, chassis wiped
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Keratometer (Manual)
+ Add Another Manual Keratometer
Room:
Manufacturer
Essilor
Bausch & Lomb
Topcon
Marco
Reichert
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Steel calibration ball test pass (40.50D / 44.75D / 48.00D verified)
Eyepiece focus & crosshair reticle sharp and zeroed
Mires illumination lamp & reflection targets bright and even
Horizontal and vertical power drums & axis rotation smooth
Chinrest elevation and table mount locked securely
Final Site Actions
Exterior wiped down and chinrest sanitized
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Manual Lensometer
+ Add Another Manual Lensometer
Room:
Manufacturer
Essilor
Marco
Reichert
Topcon
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Eyepiece reticle focus and power wheel calibrated to 0.00D
Target mires (corona / cross-line) clear and lamp illumination verified
Prism compensator scale zeroed and operates without binding
Lens marker inked, aligned and center pin verified on target
Lens stage lever, table guide bar & clamping arm smooth
Final Site Actions
Eyepiece, nosepiece and chassis wiped clean
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Digital Lensometer
+ Add Another Digital Lensometer
Room:
Manufacturer
Essilor
Topcon
Reichert
Nidek
Marco
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Self-calibration & zero point verified (Sph / Cyl accuracy with trial lens)
LCD / Touch screen responsive & tilt angle mechanism smooth
Progressive / multifocal lens detection & add power mapping verified
UV & Blue light transmittance sensors functioning (if equipped)
Lens marking cartridge inked & marking pins aligned
Thermal printer pass & RS-232 / LAN / wireless data export verified
Final Site Actions
Nosepiece cleaned and screen wiped with microfiber cloth
Protected with dust cover upon installation
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Hand Held Scopes
+ Add Another Hand Held Scope Set
Room:
Manufacturer
Essilor
Welch Allyn
Heine
Keeler
Models
S/N
Condition
New
Good
Fair
Poor
Inspection
Verified optics and mirror/apertures are clean
Mechanical functions (aperture selection, sleeve focus)
Light functionality & rheostat control
Charging well indicators & handle battery seated
User Instructed:
Charge handles for at least 24hr initially
Final Site Actions
Boxes and packing material removed
Consulted with customer regarding desk / well placement
Clean area with vacuum after install
Installed and functional
Yes
No
Acuity Chart / Projector
+ Add Another Acuity Chart
Room:
Manufacturer
Essilor
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Working distance calibration verified (direct or mirror system)
Remote control pairing & channel synchronization verified
First-surface mirror alignment and line-of-sight clear
Wall bracket secured with proper anchors
Polarized / red-green optotype masks functioning
Final Site Actions
Cable management & concealers secured
Boxes & packing removal
Clean area with vacuum after install
Installed and functional
Yes
No
Binocular Indirect (BIO)
+ Add Another BIO
Room:
Manufacturer
Essilor
Heine (Omega)
Keeler (Vantage / All Pupil)
Welch Allyn
Neitz
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Headband circumference & crown tension adjustment knobs secure
Interpupillary distance (PD) slide mechanism smooth and balanced
Optical mirrors and viewing oculars inspected & dust-free
LED / bulb brightness, aperture dial & red-free/cobalt filters verified
Lithium battery pack charging cradle or wall console tested
Final Site Actions
Headband padding and ocular chassis sanitized
Mounted charging cradle or provided carrying case storage
Clean area with vacuum after install
Boxes and packing material removed
Installed and functional
Yes
No
Trial Frame
+ Add Another Trial Frame
Room:
Manufacturer
Essilor
Oculus
Richmond
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Mechanical dials (PD, temple angle, nose bridge height) smooth
Lens cell alignment & 360° axis rotation smooth
Spoke with customer for storage/placement
Site Actions
Wipe down equipment
Boxes & packing removal
Clean area with vacuum after install
Installed and functional
Yes
No
Trial Lens Set
+ Add Another Trial Lens Set
Room:
Manufacturer
Essilor
Oculus
Richmond
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Set is complete (Sph, Cyl, Prisms, Aux lenses accounted for)
Spoke with customer for storage/placement
Site Actions
Wipe down case, tray, and clean lenses
Boxes & packing removal
Clean area with vacuum after install
Installed and functional
Yes
No
Indirect Ophthalmoscope
+ Add Another Indirect
Room:
Manufacturer
Essilor
Heine
Keeler
Welch Allyn
Model
S/N
Condition
New
Good
Fair
Poor
Inspection
Wall transformer mounted using proper anchors for wall type
Cable management & coiled power harness verified
Viewing eyepieces and mirrors clean
Headband adjustment, PD slider & aperture selectors smooth
Illumination intensity, filters & spot size control verified
Charging cradle / battery pack operational
Final Site Actions
Boxes and packing material removed
Consulted with customer regarding wall bracket mounting
Clean area with vacuum after install
Installed and functional
Yes
No
Signatures & Sign-off
Customer Approval: (Signature)
Clear Customer Signature
Customer Printed Name
Ophthalmic Field Service Technician: (Signature)
Clear Technician Signature
Technician Printed Name
Complete Installation Report