LASER WARNING SIGN REQUEST FORM

Instructions:

Each laboratory has a room sign that provides safety information to visitors and housekeeping personnel. In addition, Class 3 and 4 laser labs must also have signs that meet ANSI Z136.1–2000 requirements. The principal investigator is responsible for assuring that appropriate warning information is included on the sign. Please allow 2–4 weeks for processing.

* EHRS provides Laser Warning Signs to University of Pennsylvania Laboratories ONLY. No outside requests please.

the Class and type of laser(s) in your lab(s).

Room	Class (select one)				Type (select one and provide information as required)					Maximum Power Output
	2	3a	3b	4	Nd:YAG	Helium/Neon	Dye	Excimer:	Other
	2	3a	3b	4	Nd:YAG	Helium/Neon	Dye	Excimer:	Other
	2	3a	3b	4	Nd:YAG	Helium/Neon	Dye	Excimer:	Other
	2	3a	3b	4	Nd:YAG	Helium/Neon	Dye	Excimer:	Other
	2	3a	3b	4	Nd:YAG	Helium/Neon	Dye	Excimer:	Other

	UV radiation produced,	rooms:
	IR radiation produced,	rooms:
	Non-enclosed beam,	rooms:
Special Precautionary Instructions:
	Knock Before Entering,	rooms:
	Do Not Enter when light is on,	rooms:

* Submitted by:
* School/Dept.:
* Email Address:
* Room/Mail Code:
* Phone Number:
* Indicates required field

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