Laser Registration Form

(To be filled out by Head of the group, Supervisor, etc.)

Building: _______________ Department: ___________________ Room: _______

Manufacturer: ________________ Model: _______________ Date of purchase: _________

Type of Laser: ______________ Energy level: ____________

Hazard classification: __________ Wavelength: _____________

Intended use: ________________________________________________________________

____________________________________________________________________________

Safety measures:

General: _________________________ _________________________ _________________________

Personal: _________________________ _________________________ _________________________

Supervisor, head of group: _________________________________

Intended Users: __________________________________________________________________

_______________________________________________________________________________

Signature: _______________________ Date: __________________