Contact Lens Case Sanitization Log Form
Record each cleaning and sanitization activity for contact lens cases to ensure proper hygiene and compliance.
Date of Sanitization
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Time of Sanitization
*
Hour Minutes
AM
PM
AM/PM Option
Person Responsible
*
First Name
Last Name
Contact Lens Case ID or Label
*
Sanitization Method Used
*
Manual Wash
Chemical Disinfection
UV Sanitizer
Other
Cleaning Agent or Product Used
*
Please Select
Saline Solution
Hydrogen Peroxide
Multipurpose Solution
Alcohol-based Cleaner
Other
Duration of Sanitization (minutes)
*
Condition of Case Before Cleaning
*
Clean
Slightly Dirty
Heavily Soiled
Condition of Case After Cleaning
*
Clean
Stains Remaining
Odor Remaining
Additional Notes or Issues Observed
Submit Log Entry
Should be Empty: