+-----------------------------------------------------------------------+
| **Laser Safety Program**                                              |
|                                                                       |
| **Safety and Environmental Protection Program**                       |
|                                                                       |
| **SAIC-Frederick, NCI-Frederick**                                     |
|                                                                       |
| **Created June 1996**                                                 |
|                                                                       |
| **Revised October 2003**                                              |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

**CONTENTS**

1\. PURPOSE 1

2\. SCOPE AND APPLICATION 1

3\. REFERENCES 1

4\. DEFINITIONS 2

5\. RESPONSIBILITIES 3

> 5.1 Managers and Supervisors 3
>
> 5.2 Laser Safety Officer (LSO) 3
>
> 5.3 Occupational Health Services 4
>
> 5.4 Laser Operators 4

6\. LASER/LASER SYSTEM HAZARD CLASSIFICATIONS 4

> 6.1 Class-I Laser/Laser System 5
>
> 6.2 Class-II Laser/Laser (Low-Power) System 5
>
> 6.3 Class-III Laser/Laser (Medium-Power) System 5
>
> 6.4 Class-IV Laser/Laser (High-Power) System 5
>
> 6.5 Embedded Laser/Laser System 6
>
> 6.6 Fiber Optics and Laser/Laser System Classifications 6

7\. HAZARDS ASSOCIATED WITH A LASER/LASER SYSTEM 7

8\. REQUIREMENTS 8

> 8.1 Education and Training 8
>
> 8.2 Modifications 8
>
> 8.3 Hazardous Materials Control 8
>
> 8.4 Engineering and Administrative Controls 8
>
> 8.4.1 Laser-Controlled Area (LCA) 9
>
> 8.4.2 Laser Interlocks 10
>
> 8.4.3 Nominal Hazard Zones (NHZs) 10
>
> 8.4.4 Temporary Laser-Controlled Area 10

8.5 Personal Protective Equipment (PPE) 11

8.6 Lasers in Construction 12

8.7 Safety Signs and Labels 12

8.8 Laser Inspections 13

8.9 Medical Surveillance 13

**APPENDICES**

APPENDIX A --- Laser Registration Form 14

APPENDIX B --- Laser Safety Self-Assessment Worksheet 16

APPENDIX C --- Laser Safety Signs 17

APPENDIX D --- Laser Inspection Worksheet 18

1.  PURPOSE

    This section establishes and implements requirements and assigns
    responsibilities for NCI-Frederick laser safety in accordance with
    the requirements of American National Standards
    Insti­tute (ANSI) Z136.1(2000), *American National Standard for the
    Safe Use of Lasers*;

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1.  SCOPE AND APPLICATION

    This section applies to lasers/laser systems used at NCI-Frederick
    whether purchased, borrowed, fabricated, or brought in for use by
    others. It is intended for use by NCI-Frederick employees and
    outside personnel who work with or on lasers/laser systems. This
    section addresses the following laser-safety elements:

    M Responsibilities

    M Associated nonbeam hazards

    M Education and training

    M Laser/laser system classifications

    M Engineering and administrative controls

    M Personal protective equipment (PPE)

    M Inventory and inspection

    M Medical surveillance.

2.  REFERENCES

    1.  American National Standards Institute:

        M Z136.1(2000), *American National Standard for the Safe Use of
        Lasers*.

    2.  Code of Federal Regulations, Title 21:

        M Part 1040.10, *Laser Products*.

        M Part 1040.11, *Specific Purpose Laser Products*.

    3.  Code of Federal Regulations, Title 29:

        M Part 1910.147, *The Control of Hazardous Energy*.

        M Part 1910.133, *Eye and Face Protection*.

        M Part 1926.54, *Non-ionizing Radiation*.

    4.  Occupational Safety and Health Ad­ministra­tion PUB 8-1.7,
        *Guidelines for Laser Safety and Hazard Assessment*.

    5.  Laser Institute of America, Guide for the Selection of Laser Eye
        Protection.

3.  DEFINITIONS

    ***[Accessible Emissions Limit (AEL)]{.underline}***. The maximum
    accessible emission level permitted within a particular class.

    ***[Beam]{.underline}***. A collection of rays that may be parallel,
    divergent, or convergent.

    ***[Embedded Laser]{.underline}***. A laser housed in a system with
    a classification less than the laser classification, due to the
    engineering features limiting accessible emission.

    ***[Fail-Safe Interlock]{.underline}***. An interlock where the
    failure of a single mechanical or electrical component of the
    interlock will cause the system to go into, or remain in, a safe
    mode.

    ***[High Power]{.underline}***. For the purposes of this section,
    refers to laser emissions greater than 0.5 W.

    ***[Laser]{.underline}***. A device that produces an intense,
    coherent, directional beam of light by stimu­lating electronic or
    molecular transitions to lower energy levels.

    ***[Laser Safety Officer (LSO)]{.underline}***. An individual,
    designated by the Manager, Safety and Environmental Protection
    Program, who has the background and training to evaluate and control
    laser hazards.

    ***[Laser System]{.underline}***. An assembly of electrical,
    mechanical, and optical components that includes a laser.

    ***[Maximum Permissible Exposure (MPE)]{.underline}***. The level of
    laser radiation a person may be exposed to without hazardous effects
    or adverse biological changes in the eye or skin.

    ***[Nominal Hazard Zone (NHZ)]{.underline}***. A physical space
    where the level of direct, reflected, or scattered radiation during
    normal operation exceeds the applicable MPE. Exposure levels beyond
    the boundary of the NHZ are below the appropriate MPE level.

    ***[Reflection, Diffuse]{.underline}***. A change in the spatial
    distribution of a beam of radiation when it is reflected in many
    directions by a surface or by a medium.

    ***[Reflection, Specular]{.underline}***. A mirror-like deviation of
    radiation following incidence on a surface.

4.  RESPONSIBILITIES

    1.  [Managers and Supervisors]{.underline} have responsibility for:

        1.  Assuming overall responsibility for the safe operation of
            all lasers operated by their personnel.

        2.  Ensuring that laser operators are trained in the safe
            operation of the laser for which they are registered.

        3.  Ensuring all laser operators have satisfied the medical
            requirements of

            Subsec­tion .

        4.  Completing a Laser Registration Form (Ref. Appendix A) for
            each laser used in their area and maintaining a copy.

        5.  Upon a change in status of any laser under his/her
            responsibility, completing a Laser Registration Form and
            obtaining the required approval signature from the
            appropriate manager.

        6.  Requesting a change of registration from the LSO if the
            laser is removed from its primary facility/area for more
            than six months.

        7.  Performing periodic self-assessments on lasers/laser
            operations and document­ing the self-assessments on Appendix
            B, Laser Safety Self-Assessment Worksheet.

        8.  Ensuring Class-IIIb and -IV laser operations have written
            operating and alignment procedures, and that these
            procedures are approved by the Laser Safety Officer.

            **5.2** The **[Laser Safety Officer (LSO)]{.underline}** has
            responsibility for:

            **\[1\]** Annually reviewing and, when necessary, revising
            this Program to ensure compliance with all applicable
            federal and state regulations.

            **\[2\]** Serving as a liaison with NCI-Frederick personnel
            in matters regarding laser safety.

            **\[3\]** Assisting line management with interpretation of
            laser safety requirements.

            **\[4\]** Maintaining copies of the Laser Registration Forms
            (ref.Appendix A) for all lasers/laser systems in use at
            NCI-Frederick.

            **\[5\]** Recommending measures to line management for the
            control of nonbeam hazards.

            **\[6\]** Conducting annual inspections of each registered
            laser at NCI-Frederick and conducting additional laser
            inspections at the request of laser operators.

            **\[7\]** Maintaining current inspection records for each
            registered laser at NCI- Frederick.

            **\[8\]** Working with line management to develop, schedule,
            present, and document laser safety training for all
            employees and outside personnel who work with or on a
            laser/laser system. (The training must meet the require­ments
            of ANSI Z136.1.)

            **5.3** **[Occupational Health Services]{.underline}** has
            responsibility for maintaining laser eye exam information as
            part of the medical files for all registered NCI-Frederick
            laser operators.

            **5.4 [Laser Operators]{.underline}** have responsibility
            for:

            **\[1\]** Operating all laser/laser systems in accordance
            with the manufacturer\'s requirements and/or an approved
            operating and alignment procedure.

            **\[2\]** Verifying laser-controlled-area (LCA) interlocks
            are functioning properly before conducting any laser
            operations.

            **\[3\]** Working with the LSO to identify risks for the
            documentation of a nominal hazard zone (NHZ) for each
            Class-IIIb and -IV laser.

            **\[4\]** Upon receipt of a laser into the work place,
            contacting the LSO for an inspection of the laser for
            conformance with the Code of Federal Regulations (CFR),
            Title 21, Parts 1040.10, *Laser Products*, and 10­40.11,
            *Specific Purpose Laser Products,* and for registration into
            the computerized laser database.

            **\[5\]** Wearing dedicated eye protection for CO~2~, argon,
            and krypton lasers and such free of scratches.

5.  LASER/LASER SYSTEM HAZARD CLASSIFICATIONS

    The primary method for determining controls for a laser/laser system
    is based on the laser classification. Classification is based on the
    laser\'s ability to cause biological damage. This section covers
    laser, laser system, and optical-fiber-communi­cations-system (OFCS)
    classifications.

    1.  Class-I Laser/Laser System

        A Class-I laser/laser system is considered to be incapable of
        producing damaging laser emission levels and is therefore exempt
        from most control measures or other forms of surveil­lance. A
        Class-I system with an embedded laser is covered separately in
        Sub­section .

    2.  Class-II Laser/Laser (Low-Power) System

        A Class-II laser/laser system emits light in the visible portion
        of the spectrum (0.4-0.7 μm). Eye protection is normally
        afforded by the involuntary human aversion response to bright
        radiant sources. However, this laser/laser system classification
        may present some risk potential if the aversion response is
        overcome and the beam is viewed directly for extended periods of
        time.

        The Class-IIa laser/laser system is a special classification
        where the laser/laser system emits light in the visible
        spectrum, the system is intended for a specific use, and the
        output beam is not intended to be viewed directly. This
        laser/laser system must not exceed the Class-I Accessible
        Emmission Limit for an exposure duration of less than
        1000 seconds (16.7 min). This classification includes bar-code
        scanners commonly used for inventory control.

        **6.3 Class-III Laser/Laser (Medium-Power) System**

        A Class-III laser/laser system may be hazardous under
        direct-beam and specular-reflection viewing conditions, but the
        diffuse reflection is usually not a hazard. The Class-III
        classification is divided into two subclass­es, Class IIIa and
        IIIb, each with different control requirements. A Class-III
        laser/laser system should not present a fire hazard.

        **6.4 Class-IV Laser/Laser (High-Power) System**

        A Class-IV laser/laser system is a hazard to eye and skin from
        the direct beam and diffuse beam reflec­tions. A Class-IV
        laser/laser system can present a fire hazard. Any laser/laser
        system or modified laser/laser system of unknown power must be
        operated as a Class-IV laser/laser system until reclassified in
        accordance with ANSI Z13­6.1.

        **6.5 Embedded Laser/Laser System**

        An embedded laser/laser system is normally a Class-I or -IIa
        laser/laser system until opened for servicing or maintenance. At
        which time, it is then reclassified, depending on the type of
        laser inside. Laser printers, which are an example of a Class-I
        embedded laser, are exempt from the requirements of this
        section.

        Any laser/laser system can be converted to a Class-I enclosed
        laser/laser system by incorporating appropriate engineering
        controls in the laser/laser system design and obtaining approval
        from the LSO. These engineering controls enclose the laser,
        preventing personnel exposure to laser emissions, while
        permitting unrestricted access into the area, and include the
        following;

        M Protective housing

        M Interlocks (interlocks may be defeatable for maintenance
        purposes)

        M Fail-safe design

        M Attenuated viewing windows (portals)

        M Safety signs and labels (ref. Appendix C, Laser Safety Signs
        and Labels).

        **6.6 Fiber Optics and Laser/Laser System Classifications**

        A fiber-optic laser/laser system is a laser/laser system that
        employs optical cable to transmit the laser light. This
        laser/laser system is considered an enclosed system with the
        optical cable forming part of the enclosure. Disconnection of a
        connector may result in accessible laser emissions above the
        applicable Class-I AEL.

        Fiber-optic laser systems are divided into four classifications
        as listed on the following page (OFCS Service-Group Ratings).

+-----------------------------------------------------------------------+
| OFCS Service-Group Ratings                                            |
+-----------------------------------------------------------------------+
| Rating 1                                                              |
+-----------------------------------------------------------------------+
| O Any OFCS containing a light-emitting diode (LED) or laser/laser     |
| system that cannot emit accessible levels of optical emission in      |
| excess of the service-group rating 1 AEL for an emission duration of  |
| 100 seconds. It is exempt from all control measures and any form of   |
| surveillance.                                                         |
+-----------------------------------------------------------------------+
| Rating 2                                                              |
+-----------------------------------------------------------------------+
| O Any OFCS containing an LED or laser/laser system emitting in the    |
| visible light region (O.4-0.7 μm) that emits a total accessible       |
| radiant power exceeding the appropriate service-group rating 1 AEL    |
| for the maximum possible emission duration inherent in the design of  |
| the system, but not exceeding the service-group rating 1 AEL for an   |
| exposure duration of 0.25 secon­ds or less.                            |
+-----------------------------------------------------------------------+
| Rating 3a                                                             |
+-----------------------------------------------------------------------+
| O Near-infrared continuous wave or repetitively pulsed OFCSs that     |
| emit accessible radiant power in excess of the service-group rating 1 |
| AEL for an emission duration of 100 seco­nds, but cannot emit an       |
| average radiant power in excess of the AEL for service-group          |
| rating 3a.                                                            |
|                                                                       |
| O Infrared continuous wave or repetitively pulsed OFCSs that emit     |
| accessible radiant power in excess of the service-group rating 1 AEL  |
| for an emission duration of 10 seconds, but that cannot emit an       |
| average radiant power in excess of the AEL for service-group          |
| rating 3a.                                                            |
|                                                                       |
| O Visible continuous wave or repetitively pulsed OFCSs that emit      |
| accessible radiant power in excess of the service-group rating 2 AEL  |
| for an emission duration greater than 0.25 seconds, but cannot emit   |
| an average radiant power in excess of the AEL for service-group       |
| rating 3a.                                                            |
+-----------------------------------------------------------------------+
| Rating 3b                                                             |
+-----------------------------------------------------------------------+
| O Near-infrared continuous wave or repetitively pulsed OFCSs that     |
| emit accessible radiant power in excess of the service-group          |
| rating 3a AEL for an emission duration of 100 seconds, but cannot     |
| emit an average radiant power in excess of 0.5 W.                     |
|                                                                       |
| O Infrared continuous wave or repetitively pulsed OFCSs, that emit    |
| accessible radiant power in excess of the service-group rating 3a AEL |
| for an emission duration of 10 seconds, but cannot emit an average    |
| radiant power in excess of 0.5 W.                                     |
|                                                                       |
| O Visible continuous wave or repetitively pulsed OFCSs that emit      |
| accessible radiant power in excess of the service-group rating 3a AEL |
| for an emission duration of 100 seconds, but cannot emit an average   |
| radiant power in excess of 0.5 W.                                     |
+-----------------------------------------------------------------------+

1.  HAZARDS ASSOCIATED WITH A LASER/LASER SYSTEM

    Improperly used laser beams can ignite flammable materials or
    volatilize toxic or hazardous fumes, gases, debris, and radiation.
    In maintenance or normal use, the equipment and optical apparatus
    required to produce and control the laser energy may introduce
    additional risks associated with high voltage, high pressure,
    cryogenics, noise, radiation, and toxic fluids. In addition to the
    beam hazards, flashlamps can produce nonionizing radiation hazards.
    Microwave, ultraviolet, and radio frequency emmissions may be
    generated by a laser/laser system or support equipment.

2.  REQUIREMENTS

    1.  Education and Training

        1.  All personnel who use laser/laser systems in NCI-Frederick
            facilities/areas must be trained on the appropriate
            operating characteristics and safety hazards. Job-specific
            training must be completed and documented.

    2.  Modifications

        Modifications to commercial laser/laser systems must be
        evaluated and approved by the LSO.

    3.  Hazardous Materials Control

        An operator shall bring into the Nominal Hazard Zone only those
        hazardous materials that are needed for a particular laser
        operation. It is the operator\'s responsibility to ensure these
        materials are properly used, stored, and controlled. The
        operator shall not allow laser beams and reflections to impinge
        on combustible materials, explosives, flammable liquids or
        gases, or substances that decompose into highly-toxic products
        under elevated temperature, without providing adequate controls.
        The operator shall conduct or sponsor LSO-approved tests that
        establish the effects of beam interactions with hazardous
        materials. Test results must then be used to determine safe
        parameters for laser operation.

        **8.4 Engineering and Administrative Controls**

        When operating lasers/laser systems, hazards must be evaluated
        prior to operation. Engineering and administrative controls, as
        determined by the LSO, are required with the various laser
        classifications to provide a safe work environment consistent
        with the requirements of ANSI Z136.1. These controls must take
        into account the hazard potential of the laser/laser system, the
        environment in which the laser/laser system is used, and the
        personnel who may use or be exposed to the laser/laser system.
        Use of embedded Class-III and -IV laser/laser systems will
        require different controls during normal operation than during
        alignment and mainte­nance. The existence of other hazards in the
        laser environment may require additional controls.

        All Class-II and above laser/laser systems must have a written,
        LSO-approved alignment procedure and documented Nominal Hazard
        Zone. Class-IIIb and -IV laser/laser systems must have a
        standard operating procedure. Since each laser/laser system is
        unique, the LSO shall work with the user to develop a standard
        operating procedure that contains the necessary administrative
        controls and safety requirements. The procedure must include,
        but not be limited to, the following:

        M Necessary requirements for laser setup, adjustment, and
        operation. Such activities must be performed by authorized
        personnel only.

        M A caution statement indicating that direct viewing of the
        laser beam (and in some cases, the reflected beam) is extremely
        dangerous.

        M A requirement that the laser must be flashed once after the
        switch is turned off to remove most of the residual charge from
        the capacitors. (Lasers in hot cells are exempt from this
        requirement.)

        If the levels of accessible fiber-optical cable emissions exceed
        Class-I AEL, appropriate engineering and administrative
        controls, consistent with the hazards classification, must be
        applied.

        When hazardous levels of laser emissions (greater than or equal
        to the MPE) may be present at the end of optical fibers, a label
        with the appropriate signal word \"CAU­TION\" (OFCS Service Group
        Rating 2 and OFCS Service Group Rating 3a) or \"DANGER\" (OFCS
        Service Group Rating 3b) (ref. Appen­dix C) must be attached and
        the optical fiber capped off when not in use.

        **8.4.1 Laser-Controlled Area (LCA)**

        An LCA is a location in which a Class-IIIb or -IV
        laser-associated experiment or operation is conducted. The LCA
        may be a laboratory or a portion of a laboratory. The LCA is
        used as an engineering control mechanism for limiting access to
        a laser operation and must include active and administrative
        controls to limit access and exposure to nonessential personnel.
        An LCA must include the following:

        M A danger sign (ref. Appendix C)

        M Red warning light

        M Emergency shutdown feature (such as a panic button)

        M Door interlocks (with optional door interlock bypass).

        **8.4.2 Laser Interlocks**

        All Class-IIIb and -IV lasers must include the following
        engineering controls (as a minimum):

        M External interlock connector

        M Case interlocks

        M Master keyswitch.

        **8.4.3 Nominal Hazard Zones (NHZs)**

        M During Class-IIIb or -IV laser operations, beam hazards must
        be limited to NHZs.

        M NHZs must encompass all areas within an LCA where the MPE may
        be exceeded.

        M NHZs must be determined and documented by the LSO.

        **8.4.4 Temporary Laser-Controlled Area**

        A temporary laser-controlled area must be established for
        short-duration (less than six months) laser operations and where
        implementing an LCA is not practical. These areas are normally
        controlled through LSO-approved administrative controls. A
        notice sign (ref. Appendix C) will be used to indicate the
        entrance into a temporary laser-controlled area. Where
        maintenance or repair to a laser is taking place, a danger sign
        is needed for any other temporary LCAs.

        **8.5 Personal Protective Equipment (PPE)**

        When other control measures do not provide adequate means to
        prevent access to direct or reflected beams at levels above the
        MPE, PPE must be used as specified by the LSO.

        The requirements for PPE will be identified in a standard
        operating procedure. Impervious gloves, face shields, and
        disposable coveralls may be required for handling certain types
        of dyes and solvents. Personal protective equipment may be
        required when operating ultraviolet or Class-IV lasers. Personal
        protective equipment used with Class-IV laser/laser systems must
        be fire resistant.

        **Specific to Laser Eyewear**. Where possible, laser eyewear
        must be selected that meets or exceeds ANSI Z87.1,­ *American
        National Standard for Occupational and Educational Eye and Face
        Protection*. The LSO shall consider the following criteria and
        work with the laser operators to determine the appropriate
        eyewear.

        M Wavelength

        M MPE and optical density (OD)

        M Visible light transmission

        M Lens material

        M Mechanical construction

        M Task restrictions.

        Laser eyewear must be labeled and include:

        M the wavelength(s) for which the eyewear is designed (Dλ);

        M the attenuation at each wavelength (OD); and

        M the last LSO inspection date.

        Each set of laser eyewear must be inspected by the LSO prior to
        use and annually thereafter.

        **8.6 Lasers in Construction**

        The following requirements pertain only to lasers/laser
        operations involved in construc­tion. Where conflicts occur
        between these requirements and ANSI Z136.1, the most
        conservative requirement applies.

        1.  Special Maximum Permissible Exposure limits include:

            M Direct staring: 1 μW/cm^2^

            M Incidental: 1 m/W/cm^2^

            M Diffuse reflected: 2.5 W/cm^2^.

        2.  Protective eyewear must be worn by personnel operating a
            Class-IIIb or -IV laser.

        3.  Beam detection must be only by mechanical or electronic
            means.

        4.  The beam must be positioned below eye level whenever
            possible.

        5.  A temporary laser-controlled area must be posted, and where
            possible, constructed using physical barriers.

            **8.7 Safety Signs and Labels**

            All lasers, laser systems, and entrances to laser-controlled
            areas and Nominal Hazard Zones must be posted with signs or
            labels (as applicable) appropriate to the class of laser
            present. For example:

            M A CAUTION sign or label must be used for Class-II and
            -IIIA lasers that do not exceed the appropriate Maximum
            Permissible Exposure for irradiance.

            M A DANGER sign or label must be used for Class-IIIa lasers
            that exceeds the Maximum Permissible Exposure for
            irradiance, and Class-IIIb and -IV lasers.

            M A NOTICE sign must be posted outside a temporary
            laser-controlled area when mainte­nance is being performed
            upon Class-IIIb or -IV lasers.

            **8.8 Laser Inspections**

            **\[1\]** The LSO shall inspect all laser/laser systems upon
            initial receipt prior to operation and annually thereafter.
            Inspections must be documented using Appendix D, Laser
            Inspection Worksheet.

            **\[2\]** A laser inspection must include, but is not
            limited to:

            M Labeling (i.e., warning, aperture, access panel, and
            eyewear labels)

            M Protective housing

            M Safety interlocks on housing and access panels

            M Remote interlock (Class IIIb and IV only)

            M Key control (Class IIIb and IV only)

            M Emissions indicator

            M Beam attenuator

            M Operating controls

            M Manual reset (Class IV only)

            M Associated hazards.

            **8.9 Medical Surveillance**

            Prior to the operation of any Class-IIIb of -IV laser/laser
            system, the laser operator must obtain an initial dilated
            pupil eye exam for baseline. Laser eye exams should include
            history, visual acuity, retinal exam, and corneal
            observations (scars, burns) and are scheduled by
            Occupational Health Services.

            If an operator suspects an eye strike OHS must be informed,
            and a new dilated pupil eye exam must be completed to
            determine whether any eye damage has occurred.

            Upon termination of employment, a final laser eye exam must
            be completed to determine if any undetected eye damage has
            occurred during employment. The laser eye exam request must
            be turned in to Occupational Health Services at least two
            weeks prior to the termination date to allow for scheduling.

  -----------------------------------------------------------------------
  **NOTE** *There is no requirement for periodic laser eye exams.*

  -----------------------------------------------------------------------

**Appendix A**

Page 1 of 2

(Form is shown smaller than actual size.)

<table style="width:100%;">
<colgroup>
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 18%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 10%" />
<col style="width: 8%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="16"><strong>LASER REGISTRATION FORM</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">Check one:</td>
<td colspan="6">G Add to database G Change/up­date data­base</td>
<td colspan="8"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3">Laser type:</td>
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="3">Manufacturer:</td>
<td colspan="14"></td>
</tr>
<tr class="odd">
<td colspan="3">Property No.:</td>
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="3">Model No.:</td>
<td colspan="14"></td>
</tr>
<tr class="odd">
<td colspan="3">Serial No.:</td>
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="3"><p>Wavelength range:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="7"></td>
<td colspan="7">ηmeters / μmeters</td>
</tr>
<tr class="odd">
<td colspan="3"><p>Maximum peak power:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="7"></td>
<td colspan="7">W(s) / mW(s) / μW(s)</td>
</tr>
<tr class="even">
<td colspan="3"><p>Maximum peak energy:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="7"></td>
<td colspan="7">Joule(s) / mJoule(s) / μJoule(s)</td>
</tr>
<tr class="odd">
<td colspan="3"><p>Minimum pulse dura­tion:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="7"></td>
<td colspan="7">μsecond(s) / ηsecond(s) / ρsec­on­d(s)</td>
</tr>
<tr class="even">
<td colspan="3"><p>Minimum pulse repeti­tion fre­quen­cy:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="7"></td>
<td colspan="7">Pulses: per second / per min­ute</td>
</tr>
<tr class="odd">
<td colspan="3">Primary location:</td>
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="3">Laser class (check one):</td>
<td colspan="14">G Class-I Embedded Laser G Class II G Class IIIa G
Class IIIb G Class IV</td>
</tr>
<tr class="odd">
<td colspan="3">Safety inspection</td>
<td colspan="2">Initial date:</td>
<td colspan="2"></td>
<td colspan="2">Last date:</td>
<td colspan="3"></td>
<td colspan="3">Due date:</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Posi­tion:</td>
<td colspan="3"></td>
<td colspan="2">Signa­ture:</td>
<td colspan="5"></td>
<td colspan="3">Date:</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="13">Additional informa­tion. Include name(s) of laser
operator(s) with type of training and date(s) received.</td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td></td>
</tr>
</tbody>
</table>

**Appendix A**

Page 2 of 2

**Instructions for Completing Laser Registration Form**

***Check one***. Identify whether this is an addition or update to the
database.

***Laser type***. Identify the lasing medium used for the laser in
question (i.e., HeNe, Nd:YAG).

***Manufacturer***. Identify the laser manufacturer.

***Property No.*** Identify the laser-head property number.

***Model No.*** Identify the laser-head model number.

***Serial No.*** Identify the laser-head serial number.

***Wavelength range***. If the laser has a frequency mixing device
present in the same case, identify the operating wavelengths leaving the
laser case. Circle the appropriate unit at right. \[This can vary from a
single wavelength for lasers (such as a HeNe) to multiple wavelengths
for ion and dye lasers.\] Enter N/A if not applicable.

***Maximum peak power***. For CW lasers, identify the maximum peak power
for repetition rates. Enter N/A for non-CW lasers. Circle appropriate
unit at right.

***Maximum peak energy***. Applicable to pulsed lasers only --- Circle
appropriate unit at right. Enter N/A for CW-only lasers.

***Minimum Pulse duration***. Applicable to pulsed lasers only ---
Circle appropriate unit at right. Enter N/A for CW-only lasers.

***Minimum pulse repetition frequency (PRF)***. Applicable to pulsed
lasers only --- Identify all repetition rates at which the laser will
operate. Enter N/A for CW-only lasers. Circle appropriate unit at right.

***Primary location***. Identify the primary location of the laser. Be
specific to the building number where it is located.

  -----------------------------------------------------------------------
  **NOTE** *If this location is changed for more than six months, an
  update form must be submitted to include this information.*

  -----------------------------------------------------------------------

***Laser class***. Check appropriate class. If the system contains an
embedded laser, enter the appropriate laser classification for the
embedded laser in the space provided.

***Safety inspection***. Inspect the laser for conformance to
21 CFR-1040. **LSO ---** Sign this section upon inspection completion
and enter the due date for the next inspection (12 months from last
laser inspection date).

***Position/Signature/Date***. **Responsible Manager ---** Sign and date
to indicate that the information on the form is valid.

***Additional information***: Include information regarding specific
dyes, gases, etc., used with the laser. Include descriptions; serial,
property, and model numbers of support equipment necessary to make the
laser lase (such as power supplies, flow controls).

**Appendix B**

Page 1 of 1

(Form is shown smaller than actual size.)

+---------+-----------------------------------------+------+---+----------+
| **LASER |                                         |      |   |          |
| SAFETY  |                                         |      |   |          |
| S       |                                         |      |   |          |
| ELF-AS­S |                                         |      |   |          |
| E­SS­MENT |                                         |      |   |          |
| WORK    |                                         |      |   |          |
| SH­EET** |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Area:   |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Sup     |                                         | D    |   |          |
| ervisor |                                         | ate: |   |          |
| (Name   |                                         |      |   |          |
| and     |                                         |      |   |          |
| Sign    |                                         |      |   |          |
| a­ture): |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| *       |                                         |      | * |          |
| *Item** |                                         |      | * |          |
|         |                                         |      | ­S |          |
|         |                                         |      | u |          |
|         |                                         |      | p |          |
|         |                                         |      | e |          |
|         |                                         |      | r |          |
|         |                                         |      | v |          |
|         |                                         |      | i |          |
|         |                                         |      | s |          |
|         |                                         |      | o |          |
|         |                                         |      | r |          |
|         |                                         |      | * |          |
|         |                                         |      | * |          |
|         |                                         |      |   |          |
|         |                                         |      | * |          |
|         |                                         |      | * |          |
|         |                                         |      | I |          |
|         |                                         |      | n |          |
|         |                                         |      | i |          |
|         |                                         |      | t |          |
|         |                                         |      | i |          |
|         |                                         |      | a |          |
|         |                                         |      | l |          |
|         |                                         |      | s |          |
|         |                                         |      | * |          |
|         |                                         |      | * |          |
+---------+-----------------------------------------+------+---+----------+
| **Tra   |                                         |      |   |          |
| ining** |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Laser   |                                         |      |   |          |
| op      |                                         |      |   |          |
| erators |                                         |      |   |          |
| are     |                                         |      |   |          |
| trained |                                         |      |   |          |
| in      |                                         |      |   |          |
| general |                                         |      |   |          |
| laser   |                                         |      |   |          |
| safety. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Laser   |                                         |      |   |          |
| op      |                                         |      |   |          |
| erators |                                         |      |   |          |
| are     |                                         |      |   |          |
| trained |                                         |      |   |          |
| to      |                                         |      |   |          |
| job-s   |                                         |      |   |          |
| pecific |                                         |      |   |          |
| fun     |                                         |      |   |          |
| ctions. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| **R     |                                         |      |   |          |
| equired |                                         |      |   |          |
| Inspec  |                                         |      |   |          |
| tions** |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Lase    |                                         |      |   |          |
| r-contr |                                         |      |   |          |
| ol-area |                                         |      |   |          |
| in      |                                         |      |   |          |
| terlock |                                         |      |   |          |
| insp    |                                         |      |   |          |
| ections |                                         |      |   |          |
| are     |                                         |      |   |          |
| c       |                                         |      |   |          |
| urrent. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Lasers  |                                         |      |   |          |
| in use  |                                         |      |   |          |
| are     |                                         |      |   |          |
| reg     |                                         |      |   |          |
| istered |                                         |      |   |          |
| in the  |                                         |      |   |          |
| NC      |                                         |      |   |          |
| I-FCRDC |                                         |      |   |          |
| da      |                                         |      |   |          |
| tabase. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Laser   |                                         |      |   |          |
| insp    |                                         |      |   |          |
| ections |                                         |      |   |          |
| for     |                                         |      |   |          |
| lasers  |                                         |      |   |          |
| in use  |                                         |      |   |          |
| are     |                                         |      |   |          |
| c       |                                         |      |   |          |
| urrent. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| **Engi  |                                         |      |   |          |
| neering |                                         |      |   |          |
| Con     |                                         |      |   |          |
| trols** |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Lase    |                                         |      |   |          |
| r-contr |                                         |      |   |          |
| ol-area |                                         |      |   |          |
| int     |                                         |      |   |          |
| erlocks |                                         |      |   |          |
| are     |                                         |      |   |          |
| opera   |                                         |      |   |          |
| tional. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Lase    |                                         |      |   |          |
| r-contr |                                         |      |   |          |
| ol-area |                                         |      |   |          |
| in      |                                         |      |   |          |
| terlock |                                         |      |   |          |
| bypass  |                                         |      |   |          |
| systems |                                         |      |   |          |
| are     |                                         |      |   |          |
| being   |                                         |      |   |          |
| used    |                                         |      |   |          |
| appropr |                                         |      |   |          |
| iate­ly. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| C       |                                         |      |   |          |
| ontrols |                                         |      |   |          |
| are     |                                         |      |   |          |
| appr    |                                         |      |   |          |
| opriate |                                         |      |   |          |
| to      |                                         |      |   |          |
| h       |                                         |      |   |          |
| azards. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Class-I |                                         |      |   |          |
| e       |                                         |      |   |          |
| mbedded |                                         |      |   |          |
| laser   |                                         |      |   |          |
| system  |                                         |      |   |          |
| requi   |                                         |      |   |          |
| rements |                                         |      |   |          |
| met.    |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| **Pe    |                                         |      |   |          |
| rsonnel |                                         |      |   |          |
| Pro     |                                         |      |   |          |
| tective |                                         |      |   |          |
| Eq      |                                         |      |   |          |
| uipment |                                         |      |   |          |
| (PPE)** |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Any     |                                         |      |   |          |
| LSO-r   |                                         |      |   |          |
| equired |                                         |      |   |          |
| eye     |                                         |      |   |          |
| pro     |                                         |      |   |          |
| tection |                                         |      |   |          |
| av      |                                         |      |   |          |
| ailable |                                         |      |   |          |
| and     |                                         |      |   |          |
| p       |                                         |      |   |          |
| roper­ly |                                         |      |   |          |
| l       |                                         |      |   |          |
| abeled. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| The     |                                         |      |   |          |
| appr    |                                         |      |   |          |
| opriate |                                         |      |   |          |
| PPE     |                                         |      |   |          |
| av      |                                         |      |   |          |
| ailable |                                         |      |   |          |
| for     |                                         |      |   |          |
| nonbeam |                                         |      |   |          |
| h       |                                         |      |   |          |
| azards. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| **      |                                         |      |   |          |
| Adminis |                                         |      |   |          |
| trative |                                         |      |   |          |
| Con     |                                         |      |   |          |
| trols** |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Current |                                         |      |   |          |
| al      |                                         |      |   |          |
| ignment |                                         |      |   |          |
| pr      |                                         |      |   |          |
| ocedure |                                         |      |   |          |
| ava     |                                         |      |   |          |
| ilable. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| The     |                                         |      |   |          |
| al      |                                         |      |   |          |
| ignment |                                         |      |   |          |
| pr      |                                         |      |   |          |
| ocedure |                                         |      |   |          |
| covers  |                                         |      |   |          |
| all     |                                         |      |   |          |
| nonbeam |                                         |      |   |          |
| h       |                                         |      |   |          |
| azards; |                                         |      |   |          |
| appr    |                                         |      |   |          |
| opriate |                                         |      |   |          |
| c       |                                         |      |   |          |
| ontrols |                                         |      |   |          |
| in      |                                         |      |   |          |
| place.  |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Nominal |                                         |      |   |          |
| hazard  |                                         |      |   |          |
| zones   |                                         |      |   |          |
| are     |                                         |      |   |          |
| ide     |                                         |      |   |          |
| ntified |                                         |      |   |          |
| for     |                                         |      |   |          |
| Cla     |                                         |      |   |          |
| ss-IIIb |                                         |      |   |          |
| and -IV |                                         |      |   |          |
| laser   |                                         |      |   |          |
| oper    |                                         |      |   |          |
| a­tions. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Al      |                                         |      |   |          |
| ignment |                                         |      |   |          |
| pro     |                                         |      |   |          |
| cedures |                                         |      |   |          |
| are     |                                         |      |   |          |
| av      |                                         |      |   |          |
| ailable |                                         |      |   |          |
| for     |                                         |      |   |          |
| Cla     |                                         |      |   |          |
| ss-IIIb |                                         |      |   |          |
| and -IV |                                         |      |   |          |
| laser   |                                         |      |   |          |
| oper    |                                         |      |   |          |
| a­tions. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+
| Op      |                                         |      |   |          |
| erating |                                         |      |   |          |
| pro     |                                         |      |   |          |
| cedures |                                         |      |   |          |
| are     |                                         |      |   |          |
| av      |                                         |      |   |          |
| ailable |                                         |      |   |          |
| for     |                                         |      |   |          |
| Cla     |                                         |      |   |          |
| ss-IIIb |                                         |      |   |          |
| and -IV |                                         |      |   |          |
| laser   |                                         |      |   |          |
| oper    |                                         |      |   |          |
| a­tions. |                                         |      |   |          |
+---------+-----------------------------------------+------+---+----------+

**Appendix C**

Page 1 of 1

**Laser Safety Signs and Labels**

![](media/image1.wmf){width="4.0in" height="4.5in"}

![](media/image3.wmf){width="3.4902777777777776in" height="3.0in"}

**Appendix D**

Page 1 of 1

(Form is shown small­er than actual size.)

+-----------------------+------------------------------+------+---+-----+
| **LASER INSPECTION    |                              |      |   |     |
| WORKSH­EET**           |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Laser type:**       |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Laser serial No.:** |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Laser Safety        |                              | *    |   |     |
| Officer**             |                              | *Dat |   |     |
|                       |                              | e:** |   |     |
| **(Name and           |                              |      |   |     |
| Sig­na­ture):**         |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Item**              |                              |      |   | *   |
|                       |                              |      |   | *LS |
|                       |                              |      |   | O\' |
|                       |                              |      |   | s** |
|                       |                              |      |   |     |
|                       |                              |      |   | **I |
|                       |                              |      |   | ni­t |
|                       |                              |      |   | ial |
|                       |                              |      |   | s** |
+-----------------------+------------------------------+------+---+-----+
| **Labeling**          |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| Warning Label ---     |                              |      |   |     |
| Laser(s) systems      |                              |      |   |     |
| greater than Class I  |                              |      |   |     |
| are l­a­b­e­led with a    |                              |      |   |     |
| w­a­r­n­ing l­a­b­el.        |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| Aperture Label ---    |                              |      |   |     |
| Laser(s) systems      |                              |      |   |     |
| greater than          |                              |      |   |     |
| Class-IIe s­y­s­t­ems     |                              |      |   |     |
| have a­p­e­r­t­ure w­a­r­n­ing |                              |      |   |     |
| l­a­b­els for each       |                              |      |   |     |
| a­perture.             |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| Access Panel Label    |                              |      |   |     |
| --- Access panels     |                              |      |   |     |
| that are not          |                              |      |   |     |
| inter­l­o­c­ked or have   |                              |      |   |     |
| d­e­f­e­a­t­a­ble inter­l­o­cks |                              |      |   |     |
| are properly labeled. |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Protective          |                              |      |   |     |
| Housing**             |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| The housing is at     |                              |      |   |     |
| ground potential with |                              |      |   |     |
| the laser en­e­r­g­i­z­ed.  |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| The housing has no    |                              |      |   |     |
| light leaks that      |                              |      |   |     |
| would expose the      |                              |      |   |     |
| op­e­r­a­tor to laser or  |                              |      |   |     |
| f­l­a­s­h­l­amp e­m­i­s­sion    |                              |      |   |     |
| levels greater than   |                              |      |   |     |
| Class-I AEL.          |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| If the laser has no   |                              |      |   |     |
| housing (as in the    |                              |      |   |     |
| case of some          |                              |      |   |     |
| ex­p­e­r­i­m­e­n­tal s­y­s­t­ems) |                              |      |   |     |
| the p­r­o­per con­t­r­ols   |                              |      |   |     |
| and p­r­o­c­e­d­ures are in |                              |      |   |     |
| place to protect      |                              |      |   |     |
| person­nel.            |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Safety Interlocks   |                              |      |   |     |
| (i.e., on housing and |                              |      |   |     |
| access panels)**      |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| Have been tested for  |                              |      |   |     |
| operation.            |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| Fail-safe design (for |                              |      |   |     |
| Class-IIIb and -IV    |                              |      |   |     |
| la­sers or Class-I     |                              |      |   |     |
| systems with an       |                              |      |   |     |
| e­m­b­e­d­ded Class-IIIb   |                              |      |   |     |
| or -IV l­a­s­er) has no  |                              |      |   |     |
| more than one         |                              |      |   |     |
| snap-action spring    |                              |      |   |     |
| switch.               |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Remote Interlock    |                              |      |   |     |
| (Classes IIIb and IV  |                              |      |   |     |
| only) ---** It has    |                              |      |   |     |
| been tested for       |                              |      |   |     |
| operation with LCA    |                              |      |   |     |
| interlock s­y­s­t­em.     |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Key Control         |                              |      |   |     |
| (Classes IIIb and IV  |                              |      |   |     |
| only)**               |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| The key cannot be     |                              |      |   |     |
| removed when the      |                              |      |   |     |
| laser is on.          |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| Key control is        |                              |      |   |     |
| functional.           |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Emission Indicator  |                              |      |   |     |
| ---** The indicator   |                              |      |   |     |
| is functional.        |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Beam Attenuator     |                              |      |   |     |
| ---** Either a        |                              |      |   |     |
| mechanical or         |                              |      |   |     |
| electrical device     |                              |      |   |     |
| that reduces          |                              |      |   |     |
| emis­sions to below    |                              |      |   |     |
| Class-I AEL is        |                              |      |   |     |
| installed.            |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Operating Controls  |                              |      |   |     |
| ---** They are        |                              |      |   |     |
| positioned such that  |                              |      |   |     |
| the oper­ator is not   |                              |      |   |     |
| ex­posed to the beam   |                              |      |   |     |
| during laser          |                              |      |   |     |
| opera­tion.            |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+
| **Manual Reset ---**  |                              |      |   |     |
| Class IV only --- A   |                              |      |   |     |
| manual reset is       |                              |      |   |     |
| requ­i­red to           |                              |      |   |     |
| r­e­e­n­e­r­g­ize the laser  |                              |      |   |     |
| if power is lost for  |                              |      |   |     |
| g­r­e­a­ter than 5        |                              |      |   |     |
| seconds.              |                              |      |   |     |
+-----------------------+------------------------------+------+---+-----+

+------+----------+-----------------------------------+---+-----+---+------+
|      | **LASER  |                                   |   |     |   |      |
|      | SAFETY   |                                   |   |     |   |      |
|      | SELF-AS  |                                   |   |     |   |      |
|      | ­SE­SS­MENT |                                   |   |     |   |      |
|      | WOR      |                                   |   |     |   |      |
|      | KSH­EET** |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
|      | Area:    |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
|      | Su       |                                   |   | Da  |   |      |
|      | pervisor |                                   |   | te: |   |      |
|      | (Name    |                                   |   |     |   |      |
|      | and      |                                   |   |     |   |      |
|      | Sig      |                                   |   |     |   |      |
|      | na­ture): |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
|      | **Item** |                                   |   |     | * |      |
|      |          |                                   |   |     | * |      |
|      |          |                                   |   |     | ­S |      |
|      |          |                                   |   |     | u |      |
|      |          |                                   |   |     | p |      |
|      |          |                                   |   |     | e |      |
|      |          |                                   |   |     | r |      |
|      |          |                                   |   |     | v |      |
|      |          |                                   |   |     | i |      |
|      |          |                                   |   |     | s |      |
|      |          |                                   |   |     | o |      |
|      |          |                                   |   |     | r |      |
|      |          |                                   |   |     | * |      |
|      |          |                                   |   |     | * |      |
|      |          |                                   |   |     |   |      |
|      |          |                                   |   |     | * |      |
|      |          |                                   |   |     | * |      |
|      |          |                                   |   |     | I |      |
|      |          |                                   |   |     | n |      |
|      |          |                                   |   |     | i |      |
|      |          |                                   |   |     | t |      |
|      |          |                                   |   |     | i |      |
|      |          |                                   |   |     | a |      |
|      |          |                                   |   |     | l |      |
|      |          |                                   |   |     | s |      |
|      |          |                                   |   |     | * |      |
|      |          |                                   |   |     | * |      |
+------+----------+-----------------------------------+---+-----+---+------+
| **Tr |          |                                   |   |     |   |      |
| aini |          |                                   |   |     |   |      |
| ng** |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| L    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| o    |          |                                   |   |     |   |      |
| pera |          |                                   |   |     |   |      |
| tors |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| tra  |          |                                   |   |     |   |      |
| ined |          |                                   |   |     |   |      |
| in   |          |                                   |   |     |   |      |
| gen  |          |                                   |   |     |   |      |
| eral |          |                                   |   |     |   |      |
| l    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| saf  |          |                                   |   |     |   |      |
| ety. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| L    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| o    |          |                                   |   |     |   |      |
| pera |          |                                   |   |     |   |      |
| tors |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| tra  |          |                                   |   |     |   |      |
| ined |          |                                   |   |     |   |      |
| to   |          |                                   |   |     |   |      |
| job- |          |                                   |   |     |   |      |
| spec |          |                                   |   |     |   |      |
| ific |          |                                   |   |     |   |      |
| fu   |          |                                   |   |     |   |      |
| ncti |          |                                   |   |     |   |      |
| ons. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| **   |          |                                   |   |     |   |      |
| Requ |          |                                   |   |     |   |      |
| ired |          |                                   |   |     |   |      |
| I    |          |                                   |   |     |   |      |
| nspe |          |                                   |   |     |   |      |
| ctio |          |                                   |   |     |   |      |
| ns** |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| La   |          |                                   |   |     |   |      |
| ser- |          |                                   |   |     |   |      |
| cont |          |                                   |   |     |   |      |
| rol- |          |                                   |   |     |   |      |
| area |          |                                   |   |     |   |      |
| i    |          |                                   |   |     |   |      |
| nter |          |                                   |   |     |   |      |
| lock |          |                                   |   |     |   |      |
| ins  |          |                                   |   |     |   |      |
| pect |          |                                   |   |     |   |      |
| ions |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| curr |          |                                   |   |     |   |      |
| ent. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| La   |          |                                   |   |     |   |      |
| sers |          |                                   |   |     |   |      |
| in   |          |                                   |   |     |   |      |
| use  |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| re   |          |                                   |   |     |   |      |
| gist |          |                                   |   |     |   |      |
| ered |          |                                   |   |     |   |      |
| in   |          |                                   |   |     |   |      |
| the  |          |                                   |   |     |   |      |
| N    |          |                                   |   |     |   |      |
| CI-F |          |                                   |   |     |   |      |
| rede |          |                                   |   |     |   |      |
| rick |          |                                   |   |     |   |      |
| d    |          |                                   |   |     |   |      |
| atab |          |                                   |   |     |   |      |
| ase. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| L    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| ins  |          |                                   |   |     |   |      |
| pect |          |                                   |   |     |   |      |
| ions |          |                                   |   |     |   |      |
| for  |          |                                   |   |     |   |      |
| la   |          |                                   |   |     |   |      |
| sers |          |                                   |   |     |   |      |
| in   |          |                                   |   |     |   |      |
| use  |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| curr |          |                                   |   |     |   |      |
| ent. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| *    |          |                                   |   |     |   |      |
| *Eng |          |                                   |   |     |   |      |
| inee |          |                                   |   |     |   |      |
| ring |          |                                   |   |     |   |      |
| Co   |          |                                   |   |     |   |      |
| ntro |          |                                   |   |     |   |      |
| ls** |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| La   |          |                                   |   |     |   |      |
| ser- |          |                                   |   |     |   |      |
| cont |          |                                   |   |     |   |      |
| rol- |          |                                   |   |     |   |      |
| area |          |                                   |   |     |   |      |
| in   |          |                                   |   |     |   |      |
| terl |          |                                   |   |     |   |      |
| ocks |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| oper |          |                                   |   |     |   |      |
| atio |          |                                   |   |     |   |      |
| nal. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| La   |          |                                   |   |     |   |      |
| ser- |          |                                   |   |     |   |      |
| cont |          |                                   |   |     |   |      |
| rol- |          |                                   |   |     |   |      |
| area |          |                                   |   |     |   |      |
| i    |          |                                   |   |     |   |      |
| nter |          |                                   |   |     |   |      |
| lock |          |                                   |   |     |   |      |
| by   |          |                                   |   |     |   |      |
| pass |          |                                   |   |     |   |      |
| sys  |          |                                   |   |     |   |      |
| tems |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| b    |          |                                   |   |     |   |      |
| eing |          |                                   |   |     |   |      |
| used |          |                                   |   |     |   |      |
| ap   |          |                                   |   |     |   |      |
| prop |          |                                   |   |     |   |      |
| riat |          |                                   |   |     |   |      |
| e­ly. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| Cont |          |                                   |   |     |   |      |
| rols |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| app  |          |                                   |   |     |   |      |
| ropr |          |                                   |   |     |   |      |
| iate |          |                                   |   |     |   |      |
| to   |          |                                   |   |     |   |      |
| haza |          |                                   |   |     |   |      |
| rds. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| Cla  |          |                                   |   |     |   |      |
| ss-I |          |                                   |   |     |   |      |
| embe |          |                                   |   |     |   |      |
| dded |          |                                   |   |     |   |      |
| l    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| sy   |          |                                   |   |     |   |      |
| stem |          |                                   |   |     |   |      |
| requ |          |                                   |   |     |   |      |
| irem |          |                                   |   |     |   |      |
| ents |          |                                   |   |     |   |      |
| met. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| **P  |          |                                   |   |     |   |      |
| erso |          |                                   |   |     |   |      |
| nnel |          |                                   |   |     |   |      |
| Pr   |          |                                   |   |     |   |      |
| otec |          |                                   |   |     |   |      |
| tive |          |                                   |   |     |   |      |
| E    |          |                                   |   |     |   |      |
| quip |          |                                   |   |     |   |      |
| ment |          |                                   |   |     |   |      |
| (PP  |          |                                   |   |     |   |      |
| E)** |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| Any  |          |                                   |   |     |   |      |
| LSO- |          |                                   |   |     |   |      |
| requ |          |                                   |   |     |   |      |
| ired |          |                                   |   |     |   |      |
| eye  |          |                                   |   |     |   |      |
| pr   |          |                                   |   |     |   |      |
| otec |          |                                   |   |     |   |      |
| tion |          |                                   |   |     |   |      |
| a    |          |                                   |   |     |   |      |
| vail |          |                                   |   |     |   |      |
| able |          |                                   |   |     |   |      |
| and  |          |                                   |   |     |   |      |
| prop |          |                                   |   |     |   |      |
| er­ly |          |                                   |   |     |   |      |
| labe |          |                                   |   |     |   |      |
| led. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| The  |          |                                   |   |     |   |      |
| app  |          |                                   |   |     |   |      |
| ropr |          |                                   |   |     |   |      |
| iate |          |                                   |   |     |   |      |
| PPE  |          |                                   |   |     |   |      |
| a    |          |                                   |   |     |   |      |
| vail |          |                                   |   |     |   |      |
| able |          |                                   |   |     |   |      |
| for  |          |                                   |   |     |   |      |
| non  |          |                                   |   |     |   |      |
| beam |          |                                   |   |     |   |      |
| haza |          |                                   |   |     |   |      |
| rds. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| **Ad |          |                                   |   |     |   |      |
| mini |          |                                   |   |     |   |      |
| stra |          |                                   |   |     |   |      |
| tive |          |                                   |   |     |   |      |
| Co   |          |                                   |   |     |   |      |
| ntro |          |                                   |   |     |   |      |
| ls** |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| Cur  |          |                                   |   |     |   |      |
| rent |          |                                   |   |     |   |      |
| a    |          |                                   |   |     |   |      |
| lign |          |                                   |   |     |   |      |
| ment |          |                                   |   |     |   |      |
| p    |          |                                   |   |     |   |      |
| roce |          |                                   |   |     |   |      |
| dure |          |                                   |   |     |   |      |
| av   |          |                                   |   |     |   |      |
| aila |          |                                   |   |     |   |      |
| ble. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| The  |          |                                   |   |     |   |      |
| a    |          |                                   |   |     |   |      |
| lign |          |                                   |   |     |   |      |
| ment |          |                                   |   |     |   |      |
| p    |          |                                   |   |     |   |      |
| roce |          |                                   |   |     |   |      |
| dure |          |                                   |   |     |   |      |
| co   |          |                                   |   |     |   |      |
| vers |          |                                   |   |     |   |      |
| all  |          |                                   |   |     |   |      |
| non  |          |                                   |   |     |   |      |
| beam |          |                                   |   |     |   |      |
| haza |          |                                   |   |     |   |      |
| rds; |          |                                   |   |     |   |      |
| app  |          |                                   |   |     |   |      |
| ropr |          |                                   |   |     |   |      |
| iate |          |                                   |   |     |   |      |
| cont |          |                                   |   |     |   |      |
| rols |          |                                   |   |     |   |      |
| in   |          |                                   |   |     |   |      |
| pl   |          |                                   |   |     |   |      |
| ace. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| Nom  |          |                                   |   |     |   |      |
| inal |          |                                   |   |     |   |      |
| ha   |          |                                   |   |     |   |      |
| zard |          |                                   |   |     |   |      |
| z    |          |                                   |   |     |   |      |
| ones |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| id   |          |                                   |   |     |   |      |
| enti |          |                                   |   |     |   |      |
| fied |          |                                   |   |     |   |      |
| for  |          |                                   |   |     |   |      |
| Cl   |          |                                   |   |     |   |      |
| ass- |          |                                   |   |     |   |      |
| IIIb |          |                                   |   |     |   |      |
| and  |          |                                   |   |     |   |      |
| -IV  |          |                                   |   |     |   |      |
| l    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| ope  |          |                                   |   |     |   |      |
| ra­ti |          |                                   |   |     |   |      |
| ons. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| A    |          |                                   |   |     |   |      |
| lign |          |                                   |   |     |   |      |
| ment |          |                                   |   |     |   |      |
| pr   |          |                                   |   |     |   |      |
| oced |          |                                   |   |     |   |      |
| ures |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| a    |          |                                   |   |     |   |      |
| vail |          |                                   |   |     |   |      |
| able |          |                                   |   |     |   |      |
| for  |          |                                   |   |     |   |      |
| Cl   |          |                                   |   |     |   |      |
| ass- |          |                                   |   |     |   |      |
| IIIb |          |                                   |   |     |   |      |
| and  |          |                                   |   |     |   |      |
| -IV  |          |                                   |   |     |   |      |
| l    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| ope  |          |                                   |   |     |   |      |
| ra­ti |          |                                   |   |     |   |      |
| ons. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+
| O    |          |                                   |   |     |   |      |
| pera |          |                                   |   |     |   |      |
| ting |          |                                   |   |     |   |      |
| pr   |          |                                   |   |     |   |      |
| oced |          |                                   |   |     |   |      |
| ures |          |                                   |   |     |   |      |
| are  |          |                                   |   |     |   |      |
| a    |          |                                   |   |     |   |      |
| vail |          |                                   |   |     |   |      |
| able |          |                                   |   |     |   |      |
| for  |          |                                   |   |     |   |      |
| Cl   |          |                                   |   |     |   |      |
| ass- |          |                                   |   |     |   |      |
| IIIb |          |                                   |   |     |   |      |
| and  |          |                                   |   |     |   |      |
| -IV  |          |                                   |   |     |   |      |
| l    |          |                                   |   |     |   |      |
| aser |          |                                   |   |     |   |      |
| ope  |          |                                   |   |     |   |      |
| ra­ti |          |                                   |   |     |   |      |
| ons. |          |                                   |   |     |   |      |
+------+----------+-----------------------------------+---+-----+---+------+

<table style="width:100%;">
<colgroup>
<col style="width: 9%" />
<col style="width: 3%" />
<col style="width: 17%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="20"><strong>LASER REGISTRATION FORM</strong></td>
</tr>
<tr class="even">
<td colspan="2">Check one:</td>
<td colspan="7">G Add to database G Change/up­date data­base</td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="3">Laser type:</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="3">Manufacturer:</td>
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="3">Property No.:</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="3">Model No.:</td>
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="3">Serial No.:</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="3"><p>Wavelength range:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="8"></td>
<td colspan="9">ηmeters / μmeters</td>
</tr>
<tr class="odd">
<td colspan="3"><p>Maximum peak power:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="8"></td>
<td colspan="9">W(s) / mW(s) / μW(s)</td>
</tr>
<tr class="even">
<td colspan="3"><p>Maximum peak energy:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="8"></td>
<td colspan="9">Joule(s) / mJoule(s) / μJoule(s)</td>
</tr>
<tr class="odd">
<td colspan="3"><p>Minimum pulse dura­tion:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="8"></td>
<td colspan="9">μsecond(s) / ηsecond(s) / ρsec­on­d(s)</td>
</tr>
<tr class="even">
<td colspan="3"><p>Minimum pulse repeti­tion fre­quen­cy:</p>
<p>(Circle appropriate unit)</p></td>
<td colspan="8"></td>
<td colspan="9">Pulses: per second / per min­ute</td>
</tr>
<tr class="odd">
<td colspan="3">Primary location:</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="3">Laser class (check one):</td>
<td colspan="17">G Class-I Embedded Laser G Class II G Class IIIa G
Class IIIb G Class IV</td>
</tr>
<tr class="odd">
<td colspan="3">Safety inspection</td>
<td colspan="3">Initial date:</td>
<td colspan="2"></td>
<td colspan="2">Last date:</td>
<td colspan="4"></td>
<td colspan="5">Due date:</td>
<td></td>
</tr>
<tr class="even">
<td>Posi­tion:</td>
<td colspan="4"></td>
<td colspan="2">Signa­ture:</td>
<td colspan="5"></td>
<td colspan="5">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="15">Additional informa­tion. Include name(s) of laser
operator(s) with type of training and date(s) received.</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>LASER INSPECTION WORKSH­EET</strong></td>
</tr>
<tr class="even">
<td colspan="4"><strong>Laser type:</strong></td>
<td colspan="16"></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>Laser serial No.:</strong></td>
<td colspan="16"></td>
</tr>
<tr class="even">
<td colspan="4"><p><strong>Laser Safety Officer</strong></p>
<p><strong>(Name and Sig­na­ture):</strong></p></td>
<td colspan="9"></td>
<td colspan="3"><strong>Date:</strong></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Item</strong></td>
<td colspan="2"><p><strong>LSO's</strong></p>
<p><strong>Ini­tials</strong></p></td>
</tr>
<tr class="even">
<td colspan="20"><strong>Labeling</strong></td>
</tr>
<tr class="odd">
<td colspan="18">Warning Label — Laser(s) systems greater than Class I
are l­a­b­e­led with a w­a­r­n­ing l­a­b­el.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18">Aperture Label — Laser(s) systems greater than
Class-IIe s­y­s­t­ems have a­p­e­r­t­ure w­a­r­n­ing l­a­b­els for each a­perture.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="18">Access Panel Label — Access panels that are not
inter­l­o­c­ked or have d­e­f­e­a­t­a­ble inter­l­o­cks are properly labeled.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="20"><strong>Protective Housing</strong></td>
</tr>
<tr class="odd">
<td colspan="18">The housing is at ground potential with the laser
en­e­r­g­i­z­ed.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18">The housing has no light leaks that would expose the
op­e­r­a­tor to laser or f­l­a­s­h­l­amp e­m­i­s­sion levels greater than Class-I
AEL.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="18">If the laser has no housing (as in the case of some
ex­p­e­r­i­m­e­n­tal s­y­s­t­ems) the p­r­o­per con­t­r­ols and p­r­o­c­e­d­ures are in place to
protect person­nel.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="20"><strong>Safety Interlocks (i.e., on housing and access
panels)</strong></td>
</tr>
<tr class="odd">
<td colspan="18">Have been tested for operation.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18">Fail-safe design (for Class-IIIb and -IV la­sers or
Class-I systems with an e­m­b­e­d­ded Class-IIIb or -IV l­a­s­er) has no more
than one snap-action spring switch.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Remote Interlock (Classes IIIb and IV only)
—</strong> It has been tested for operation with LCA interlock
s­y­s­t­em.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="20"><strong>Key Control (Classes IIIb and IV
only)</strong></td>
</tr>
<tr class="odd">
<td colspan="18">The key cannot be removed when the laser is on.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18">Key control is functional.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Emission Indicator —</strong> The indicator is
functional.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Beam Attenuator —</strong> Either a mechanical
or electrical device that reduces emis­sions to below Class-I AEL is
installed.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Operating Controls —</strong> They are
positioned such that the oper­ator is not ex­posed to the beam during
laser opera­tion.</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Manual Reset —</strong> Class IV only — A
manual reset is requ­i­red to r­e­e­n­e­r­g­ize the laser if power is lost for
g­r­e­a­ter than 5 seconds.</td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

**Instructions for Completing Laser Registration Form**

***Check one***. Identify whether this is an addition or update to the
database.

***Laser type***. Identify the lasing medium used for the laser in
question (i.e., HeNe, Dye).

***Manufacturer***. Identify the laser manufacturer.

***Property No.*** Identify the laser-head property number.

***Model No.*** Identify the laser-head model number.

***Serial No.*** Identify the laser-head serial number.

***Wavelength range***. If the laser has a frequency mixing device
present in the same case, identify the operating wavelengths leaving the
laser case. Circle the appropriate unit at right. \[This can vary from a
single wavelength for lasers (such as a HeNe) to multiple wavelengths
for ion and dye lasers.\] Enter N/A if not applicable.

***Maximum peak power***. For CW lasers, identify the maximum peak power
for repetition rates. Enter N/A for non-CW lasers. Circle appropriate
unit at right.

***Maximum peak energy***. Applicable to pulsed lasers only --- Circle
appropriate unit at right. Enter N/A for CW-only lasers.

***Minimum Pulse duration***. Applicable to pulsed lasers only ---
Circle appropriate unit at right. Enter N/A for CW-only lasers.

***Minimum pulse repetition frequency (PRF)***. Applicable to pulsed
lasers only --- Identify all repetition rates at which the laser will
operate. Enter N/A for CW-only lasers. Circle appropriate unit at right.

***Primary location***. Identify the primary location of the laser. Be
specific to the building number where it is located.

  -----------------------------------------------------------------------
  **NOTE** *If this location is changed for more than six months, an
  update form must be submitted to include this information.*

  -----------------------------------------------------------------------

***Laser class***. Check appropriate class. If the system contains an
embedded laser, enter the appropriate laser classification for the
embedded laser in the space provided.

***Safety inspection***. Inspect the laser for conformance to
21 CFR-1040. **LSO ---** Sign this section upon inspection completion
and enter the due date for the next inspection (12 months from last
laser inspection date).

***Position/Signature/Date***. **Responsible Manager ---** Sign and date
to indicate that the information on the form is valid.

***Additional information***: Include information regarding specific
dyes, gases, etc., used with the laser. Include descriptions; serial,
property, and model numbers of support equipment necessary to make the
laser lase (such as power supplies, flow controls).