Fillable Names of Laser Users (New Jersey Institute of Technology)

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Names of Laser Users (New Jersey Institute of Technology)

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NJIT LASER USE REGISTRATION (LUR) FORM
Date: ______________________________ Page of
Name of Principal Investigator: _________________________________________
Phone # _____________
Name of Laboratory Contacts: __________________________________________
Phone # _____________
Names of Laser Users
Laser Safety Training Completed (Date)
Department of Principal Investigator:
Laser Research Funding source (circle one)
DOE Other: _________________________________
Building and Room Location of Laser: _____________________________________________________________
Make/Model of Laser: Laser Serial Number: ________________________________________________________
Laser information
Laser Classification Marked on Laser (Circle one) 1 2 3 3a 3b 4 none
CW Pulsed
Wavelength(s): ________________ (nm) Wavelength(s) ______________________ (nm)
Max Op Power ______________________ Pulse Durations (sec) _____________________
Avg. Op. Power: _____________________
Pulse frequency _________________________
(Hz) Max. Op. Energy: ____________________
Beam Diameter at aperture: _____________________ Avg. Op. Energy: ________________________
Beam Divergence: ______________________________
Laser Use (describe briefly): _____________________________________________________________________
Place a check after all items that apply and describe:
Use of cryogen
Use of Compressed gases
High Voltage Power Supplies
High Voltage > 30K Vp
Dye Laser
Exposed Beam Paths
High Noise Levels
Use of Pumping laser
Beam Focusing Optics
Fabricated Laser
Modified Laser
Freq. Doubling Crystals
Tunable Laser
Invisible Beam Laser Cutting/Welding
EHS007 Laser Use Registration with Checklist
1
September 2015
LASER SYSTEM REQUIRED CONTROL MEASURES
Engineering Controls 1 2a 2 3a 3b 4
Protective Housing X X X X X X
Without Protective Housing
LSO shall establish alternate controls
Interlocks on Protective Housing ? ? ? X X X
Service Access Panel ? ? ? ? X X
Key Control • X
Protective Viewing Portals MPE MPE MPE MPE
Collecting Optics MPE MPE MPE MPE MPE MPE
Totally Open Beam Path X X
Limited Open Beam Path X X
Remote Interlock Connector • X
Beam Stop or Attenuator • X
Activation Warning System • X
Emission Delay X
Protective Windows MPE MPE
Administrative Controls
Written Laser Safety Procedures • X
Education and Training • • X X
Authorized Operating Personnel X X
Alignment Procedures X X
Control of Spectators • X
Service Personnel Training ? ? ? ? X X
Indoor Laser Controlled Area X X
Class 3b Laser Controlled Area X
Class 4 Laser Controlled Area X
Temporary Laser Controlled Area ? ? ? ?
Warning Labels (on laser housing) X X X X X X
Warning Sign Posting • X X
Laser sign posted on laboratory
• X X
Protective Equipment
Eye Protection MPE X
Skin Protection MPE MPE
X = Required
• = Recommended
? = Required if contains an embedded Class 3b or 4 lasers
MPE = required if the Maximum Permissible Exposure is exceeded
EHS007 Laser Use Registration with Checklist
2
September 2015
LASER SAFETY CHECKLIST
Laser Posting, Labeling and Room Control Measures Yes No NA Deficiency Noted
Entrances properly labeled and posted
Room security
Entryway interlock system
Entryway interlock system functioning
A door, blocking barrier, curtain, etc. at entry way
Protective Windows
Laser status indicator outside room
Equipment Labels
Engineering Safety Control Measures Yes No NA Deficiency Noted
Protective housing in place
Interlock on housing
Beam shutter present
Key control
Laser activation warning system (with emission delay) in place
Remote interlock connector (emergency shutoff) available
Laser secured to table
Laser optics secured to prevent stray beams
Enclosed beam path
Limited open beam path
Totally open beam path
Beam barriers in place
Beam stops in place
Beam intensity reduced through filtration
Reflective materials kept out of beam path
Remote monitoring/viewing devices
Administrative and Procedural Safety Control Measures Yes No NA Deficiency Noted
Standard operating procedures are available
Alignment procedures are available
Laser operated, maintained and serviced by authorized personnel
Spectator procedures are available
Permit holders/workers’ laser safety training completed
(general & specific) including certificate and record of training
Has homebuilt/modified laser/laser system been classified
Proper laser eye protection available
Proper skin protection available
Permit holders/workers’ eye examination completed
Non Beam Hazards Yes No NA Deficiency Noted
Cryogenic fluids in use
Compressed gas in use
Gas cylinders properly restrained
Laser generated air contaminant (LGAC) production
Electrical hazards
Collateral and plasma radiation hazard
Noise/vibration hazards
Proper disposal of chemical wastes
EHS007 Laser Use Registration with Checklist
3
September 2015
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Names of Laser Users (New Jersey Institute of Technology)

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Completed 24 August 2020

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