Laser Registry :: Laser Safety @ EHRS

LASER REGISTRY

I. PI Information

Principal Investigator ________________________________________ Phone ___________________________

Department ________________________________________ School ___________________________

Date _______________________________

II. Personnel who use laser system

Name	Penn ID# what is my Penn ID #?	Status (student or staff)
__________________________	____________________	__________________________
__________________________	____________________	__________________________
__________________________	____________________	__________________________

III. Laser System Information

1.	System location (Building/Room#)	________________________________________
2.	Laser warning sign on door (Y/N)	________________________________________
	Wording on sign	________________________________________
3.	Do users wear safety goggles?	________________________________________
	Type/Manufacturer	________________________________________
4.	Are goggles available for visitors?	________________________________________
	Type/Manufacturer	________________________________________
5.	Service for laser: in-house (Y/N)	________________________________________
	Contract service company's name	________________________________________
6.	Is there a written SOP available?	________________________________________
	Complete table below:

Manufacturer

Laser 1

Laser 2

Laser 3

Model #

Serial #

Class (1,2,3a,3b,4)

Type (CW,Pulsed)

Description (ie; He-Ne,ND: YAG)

Wavelength(s)

Maximum Power/Peak Power
(Watts or Joules)

Pulse Duration (repetition rate)

Emerging Beam Dimensions (mm)

Use (holography, alignment, etc.)

Return completed form to: EHRS, 3160 Chestnut Street, Suite 400/6287

Download Word version of Laser Registry




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