Principal Investigator ________________________________________
Phone ___________________________
Department ________________________________________
School ___________________________
Date _______________________________
| Name | Penn ID# what is my Penn ID #? | Status (student or staff) |
|---|---|---|
| __________________________ | ____________________ | __________________________ |
| __________________________ | ____________________ | __________________________ |
| __________________________ | ____________________ | __________________________ |
| 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