Laser AuthorizedUser

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					                             CENTRE FOR ENVIRONMENTAL HEALTH AND SAFETY M ANAGEMENT

                                        LASER SAFETY PROGRAM
                                   Authorized Laser User Form
                                                  (RSP- F02-2006)

       LASER SUPERVISOR: _________________________________                 PHONE: ___________________

       LASER LOCATION (Building & Room) _______________________________________

       LASER DESCRIPTION
       Laser type:  C02    Diode        He-Ne             Nd:Yag       Other______________
       Class:  Class 3b            Class 4
        Pulsed        Continuous Wave (CW)                 Other __________________

       Wavelength(s): _______________

       Max power: _____________@Wavelength _________
       Max power: _____________@Wavelength _________
       Max power: _____________@Wavelength _________


       Max Energy/pulse)    _____________@Wavelength _________
       Max Energy/pulse)    _____________@Wavelength _________
       Max Energy/pulse)    _____________@Wavelength _________


       List of authorized Class 3b and 4 laser users


                           Name of Authorized User                                Date of Laser Training




Signature of Laser Supervisor: ________________________             Date of last update: ________________________


                                    PLEASE POST LIST IN LASER AREA

				
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posted:10/3/2012
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