Application for Approval as Supervisor for Dispensing Opticians in Training

This form is to be completed and attached to the student’s application. A separate form is required for each supervisor. The supervisor must be in current good standing with this Board.

Supervisor’s Name:

Registration #

Address:

Street/PO Box

City

Postal Code

Phone

Fax#

Work Location:

Company

Owner/Manager

Street/PO Box

Town/City

Postal Code

Phone#

Fax#

Student’s name:

As an approved supervisor I accept the responsibility to instruct and train the student in all practical aspects of Optician Profession including but not limited to the following:

Please checkmark each skill that you will supervise.

How to interpret and analyze clients’ prescriptions,

determine client’s visual needs,

assist and advise clients in the selection of frames and lenses,

use of PD rule (with penlight) and Pupilometer for monocular and binocular measurement

measure PDs, Optical Centers for single vision, multifocal and progressive addition lenses (PAL) (size and heights),

take and record client's health record, enter details to clients’ files

fit and dispense the eye-wear

encourage critical thinking when problem solving clients concerns

understand routine office procedures and responsibilities of business etiquette.

Use of (manual) Lensometer to determine and verify lens power

Use of lens clock/gauge, lens callipers, millimetre rule and standards of tolerance to determine and verify base curves, lens thickness, surface quality and acceptance of lenses for purpose of dispensing to client

Use of Vertex Distometer and conversion scale

Use of frame warmer and various tools of the trade to adjust plastic and metal frames into standard alignment as well as custom fit eye-wear to client’s facial features

Use of Fabrication/Finishing Lab equipment [Lens Blocker, Formers, Edging Equipment, Tinting Equipment, Lens Grooving], insertion of lenses to common frame types, and use tools for repairing / replacing frames and parts thereof.

Understand the scope of practise and competencies of the profession and responsibilities of keeping secure client's personal health information

Signature

Max. file size: 64 MB.

Date