NJIT LASER USE REGISTRATION (LUR) FORM · 2017-01-05 · No: NA Deficiency Noted: Entrances properly labeled and posted Room security: Entryway interlock system Entryway interlock

NJIT LASER USE REGISTRATION (LUR) FORMDate: ______________________________ Page ofName 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 informationLaser Classification Marked on Laser (Circle one) 1 2 3 3a 3b 4 none CW PulsedWavelength(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 cryogenUse of Compressed gasesHigh Voltage Power SuppliesHigh Voltage > 30K VpDye LaserExposed Beam PathsHigh Noise LevelsUse of Pumping laserBeam Focusing OpticsFabricated LaserModified LaserFreq. Doubling CrystalsTunable LaserInvisible Beam Laser Cutting/Welding

EHS007 Laser Use Registration with Checklist 1 September 2015

LASER SYSTEM REQUIRED CONTROL MEASURESEngineering Controls 1 2a 2 3a 3b 4Protective Housing X X X X X XWithout Protective Housing LSO shall establish alternate controls

Interlocks on Protective Housing ? ? ? X X XService Access Panel ? ? ? ? X XKey Control • XProtective Viewing Portals MPE MPE MPE MPECollecting Optics MPE MPE MPE MPE MPE MPETotally Open Beam Path X XLimited Open Beam Path X XRemote Interlock Connector • XBeam Stop or Attenuator • XActivation Warning System • XEmission Delay XProtective Windows MPE MPEAdministrative ControlsWritten Laser Safety Procedures • XEducation and Training • • X XAuthorized Operating Personnel X XAlignment Procedures X XControl of Spectators • XService Personnel Training ? ? ? ? X XIndoor Laser Controlled Area X XClass 3b Laser Controlled Area XClass 4 Laser Controlled Area XTemporary Laser Controlled Area ? ? ? ?Warning Labels (on laser housing) X X X X X XWarning Sign Posting • X XLaser sign posted on laboratory • X XProtective EquipmentEye Protection MPE XSkin Protection MPE MPEX = Required• = Recommended? = Required if contains an embedded Class 3b or 4 lasersMPE = required if the Maximum Permissible Exposure is exceeded

EHS007 Laser Use Registration with Checklist 2 September 2015

LASER SAFETY CHECKLISTLaser Posting, Labeling and Room Control Measures Yes No NA Deficiency NotedEntrances properly labeled and postedRoom securityEntryway interlock systemEntryway interlock system functioningA door, blocking barrier, curtain, etc. at entry wayProtective WindowsLaser status indicator outside roomEquipment Labels

Engineering Safety Control Measures Yes No NA Deficiency NotedProtective housing in placeInterlock on housingBeam shutter presentKey controlLaser activation warning system (with emission delay) in placeRemote interlock connector (emergency shutoff) availableLaser secured to tableLaser optics secured to prevent stray beamsEnclosed beam pathLimited open beam pathTotally open beam pathBeam barriers in placeBeam stops in placeBeam intensity reduced through filtrationReflective materials kept out of beam pathRemote monitoring/viewing devices

Administrative and Procedural Safety Control Measures Yes No NA Deficiency NotedStandard operating procedures are availableAlignment procedures are availableLaser operated, maintained and serviced by authorized personnelSpectator procedures are availablePermit holders/workers’ laser safety training completed(general & specific) including certificate and record of trainingHas homebuilt/modified laser/laser system been classifiedProper laser eye protection availableProper skin protection availablePermit holders/workers’ eye examination completed

Non Beam Hazards Yes No NA Deficiency NotedCryogenic fluids in useCompressed gas in useGas cylinders properly restrainedLaser generated air contaminant (LGAC) productionElectrical hazardsCollateral and plasma radiation hazardNoise/vibration hazardsProper disposal of chemical wastes

EHS007 Laser Use Registration with Checklist 3 September 2015