Laser Permit Application

All Class IIIb and IV lasers at Texas A&M University are required to have a Permit from Environmental, Health & Safety. Safe laser use and procedural compliance is the responsibility of the faculty or staff member who is assigned at the Laboratory LSO. To register your laser, please provide the following information for each laser. The Laser Safety Program Manual can be found at

Date*

CONTACT INFORMATION

Permitee*

Title/Position*

Department*

Select or enter value

Office Phone Number*

Phone

Email*

I have read and understand*

the University Laser Safety Program Manual regarding laser safety and my responsibilities and authority as stated in section 4.1 (Permittee).

Permittee Signature*

Please type out your full name which serves as your signature.

Laboratory LSO signature*

(indicate if different from Permittee). Your typed name will serve as your signature.

Laser Information

Location*

Type (Dye, Gas, etc.)*

Manufacturer*

Model*

Serial #*

TAMU-CC Inventory #*

Excitation Mechanism*

Time-dependent operating properties*

(CW, pulse, mode-locked)

If CW, power in watts*

If pulsed, Maximum capable energy in joules*

Minimum pulse duration (sec)*

Maximum Pulse Frequency (per sec)*

Operating Wavelengths (nm)*

Other/Notes

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