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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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