In-House Digital Lensometer Repair Report
Customer Information
Company / Practice Name
Address
Contact Name
Contact Phone
Contact Email
Shop Service Reference
RMA / Repair Order #
Sales Order / Case #
Zoho #
Date Received / Logged
Ophthalmic Field Service Technician
Unit Identification & Incoming State
Manufacturer
Model
Serial Number (S/N)
Firmware / Software Version
Incoming Physical Condition
Good
Fair
Heavily Worn / Damaged
Customer Reported Problem / Symptoms
Diagnostic Findings & Service Operations
Technical Root Cause & Findings
Completed Service & Reconditioning Steps
Chassis opened, optical path de-dusted, and optical chamber cleaned
Hartmann multi-point sensor grid, beam splitters, and collimator lenses cleaned
Lens stop nosepiece ring inspected, cleaned, and micro-switch position verified
Lens stage table slide mechanism cleaned, tensioned, and 180° axis alignment squared
Lens clamp / holder arm spring tension and protective silicone pad inspected
3-dot marking ink pin assembly reconditioned, re-inked, and leveled
UV & Blue light transmittance sensor module cleaned and baseline calibrated
Internal thermal printer mechanism cleaned, roller adjusted, and test receipt printed
Zero-point homing & multi-power calibration verified against certified master test lens set
Progressive lens auto-detection & addition measurement algorithms validated
RS-232 / USB / LAN / Wi-Fi bidirectional data export tested
Detailed Repair & Rebuild Notes
Parts & Components Replaced
Part / SKU #
Description
Qty
Action
✕
+ Add Replaced Part
Final Calibration Metrics & Quality Assurance
0.00 D Zero Offset Test
Test Lens -5.00 D Test
Test Lens +5.00 D Test
Test Lens Cylinder / Axis Check
Prism Accuracy Check (Δ)
UV / Blue Light Transmittance Check
Progressive addition (ADD) test pass on PAL test lens
LCD display, tilt mechanism, and touch/keypad fully operational
Marking dots alignment verified horizontal and on optical center
Electrical continuity and ground safety bench test pass
Final exterior wipe down, dust cover placed, and packed for return delivery
Overall Service Status
Repair Completed — QA Passed
Pending Parts
BER (Beyond Repair)
Signatures & Service Approval
Supervisor: (Signature)
Clear Supervisor Signature
Supervisor Printed Name
Ophthalmic Field Service Technician: (Signature)
Clear Technician Signature
Technician Printed Name
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