SA0500-M Laser Registration Form

Laser Registration Form

All Class 3b and 4 lasers, including embedded Class 3b and 4 lasers, must be registered with Environmental Health and Safety Department. To register your laser, complete this form and email it to radiationsafety@utm.edu

Contact Information

Principal Investigator’s Name:

 

Principal Investigator’s Email:

 

Contact Name:

 

Contact Email:

 

All individuals operating this laser:

 

Check here if laser is in storage

Building:

 

Room:

 

Department:

 

Laser Information

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Laser Identification Information

Laser Manufacturer:

 

Model Number:

 

Serial Number:

 

Laser Type (Nd, YAG, etc.):

 

Classification (3b or 4):

 

Optical Characteristics

Wavelength (nm):

 

Beam Diameter (mm):

 

Beam Divergence (mrad):

 

Mode

  

Continuous Wave

Average Power (watts): Repetition frequency:

  

Pulsed

Joules/pulse:

  

Q-Switched

Pulse Width:

Purpose or Use:

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Comments:

SA0500-M Laser Registration Form
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