Stanford University Laser Safety Program - Laser Registration Form

BASIC INFO
Name of Principal Investigator:
Name of Main Contact Person (if not PI):
Contact Phone Number:
Department Name:
LASER ID
Type of the Laser (Argon, ND-YAG, etc.):
Make / Model of Laser:
Laser Serial Number:
SU fabricated laser? Yes No
SU modified laser? Yes No
Type of Lasing Medium (i.e. gas, dye, solid):
Laser Classification: 3b 4
Laser Location: (bldg, room)
Operation status: active inactive
LASER SPECIFICATIONS  
Wavelength: (nm)
Range of Beam Diameter: (nm)
Range of Beam Divergence: (mrad)
Mode---(select one)  

Continuous Wave?

Avg. Power: (Watts)
Max. Power: (Watts)

Pulsed OR Q-Switched?

Pulse Duration: (sec)
Pulse Frequency: (Hz)
Avg. Joules/Pulse: (J)
Max. Joules/Pulse: (J)
LASER USE
Purpose of Use (describe briefly):
PLEASE CHECK ALL ITEMS APPLY
Compressed gas(es) used  
Tunable Laser and few more  

By Health Physics (LSO) Only
CLA Number: ________________
The Inventory Number: ________________

 

By clicking on the "Submit" below you are verifiying that the above data is correct.