Fillable MBL Laser Registration Form (Marine Biological Laboratory)

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MBL Laser Registration Form (Marine Biological Laboratory)

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File type: PDF

U.S.A. forms for Marine Biological Laboratory

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MBL Laser Registration Form 9-26-18
MBL Laser Registration Form
All Class 3B or Class 4 lasers must be registered with the MBL Safety Department prior to use.
Please complete form and email to safety@mbl.edu. Safety will post laser hazard signs.
Registration Information
Principal Investigator:
Email:
Department/Center:
Phone
Number:
Date of Submission:
Period of
Operation:
Laser Device Information
Laser #1 Laser #2 Laser #3 Laser #4
Location
(Building/Room):
Manufacturer:
Model:
Serial Number:
Laser Type
(e.g. HeNe, Nd: YAG):
Laser Class (3B or 4):
Open or Closed:
Max Power (mW):
Wavelength(s) (nm):
Please provide a brief description of laser purpose in the laboratory:
The primary responsibility for ensuring the safe use of the above laser(s) resides with the
Principal Investigator. Signature indicates the acceptance of responsibility and conformance to
the requirements outlined in the MBL Laser Safety Manual.
PI Signature: ______________________________________ Date: ____________________
For MBL Safety Use Only:
Reviewed by:
Date Reviewed:
Signature:
Inspection Date:
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MBL Laser Registration Form (Marine Biological Laboratory)

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Completed 16 August 2020

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