LASER SAFETY OFFICER (LSO) ACKNOWLEDGMENT STATEMENT
A.A.C. R12-1-1434. B.
The LSO shall administer the laser radiation protection program and shall:
1. Ensure that maintenance or service for Class 3b and Class 4 lasers is
performed only by technicians trained to provide the maintenance or service
by either the manufacturer’s service organization or the registrant;
2. Approve or reject written service, maintenance, and operating procedures;
3. Investigate, document, and report all incidents as required by R12-1-1436;
4. Select protective eyewear as required by R12-1-1435, along with any other
protective equipment;
5. For health care facilities, establish authorization and operating procedures,
including preoperative and postoperative checklists, for use by operating
room personnel;
6. Ensure that authorized personnel are trained in the assessment and control
of laser hazards;
7. Select signs, symbols, and labels as required by R12-1- 1427;
8. Perform laser radiation protection surveys as required by R12-1-1421 and
R12-1-1441;
9. Classify or verify the classification of lasers and laser systems used under
the LSO’s jurisdiction;
10. Evaluate the hazard of laser use areas, treatment areas, and controlled
areas, as required by R12-1-1421(C).
I, ___________________________________am the designated Laser Safety Officer for
(Print Name)
_______________________________________________________________________
(Name of Laser Facility)
I perform all of the duties listed above in R12-1-1434.B, 1 through 10, of the Arizona
Administrative Code.
________________________________
Signature
___________________________
Date
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