Laser Safety Program

Laser Inventory Form

Campus

Building

Room #

Primary Contact

Department

Manufacturer

Model

Serial #

Medium

Type (CW/Pulsed/Ultrapulsed)

Max. Power Output

Wavelength (nm)

Class

Intended Use

(medical, research, other):

Baseline Eye examination completed by all users

Select

List of all laser users

Basic Laser Safety Training completed by all users

Select

List of all laser users

Appropriate safety goggles for all users and in good condition

Select

Laser Warning Door sign posted

Select

SOP approved by EHS and posted

Select

Training with laser manufacturer

Select

Comments

If any laser is returned to the manufacturer, discarded, or sent to other departments or institutions you must notify the University’s Office of Environmental Health and Safety Laser Safety Officer by email at mpeapell@med.miami.edu within ten (10) days of the transfer.

Write your full name to acknowledge and verify that the information above is correct to the best of your knowledge.

Send me a copy of my responses

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