Laser User Registration Form

LASER USER REGISTRATION FORM

Notes

1. The use of lasers in research poses a number of serious safety hazards. The purpose of the registration procedure is to ensure that you have received full information and instruction on these hazards and the procedures necessary to control them. The completion of this form needs to be approved by your supervisor.

2. All users of class 3B and class 4 lasers must be registered using this form prior to commencement of the laser work. The completed form must be sent immediately to the University Laser Safety Officer.

3. Before this form can be completed you will need to undergo a thorough eye test, which will make sure that there are no eye defects prior to beginning laser work. This test, which costs around £40, is carried out by an opthalmologist and currently we use Dr Karwatowski at the BUPA Hospital, Oadby. You need to book the appointment yourself and ask for a “pre-laser eye test for the University”. You do NOT need to be referred to Dr Karwatowski by your GP for this particular test. Make it clear that the invoice should be sent to your department – the University does not have a central fund for payment of laser eye tests.

REGISTRATION DETAILS
(use block capitals)
NAME AND TITLE
DEPARTMENT
STATUS (UG, PG, PDRA, ETC.)
ACADEMIC SUPERVISOR
TYPE AND CLASS OF LASER(S)
LOCATION OF LASER(S): ROOM AND BUILDING

Date of eye examination: ……………………………………….

Tick here if you do not want your name to be entered onto the University laser safety web site as a registered class 3B/4 laser user

DECLARATION

I declare that:

· I have read both the British Standards booklet for safe operation of lasers (BS 60825) and the University Laser Safety web site: https://swww2.le.ac.uk/departments/chemistry/laser-safety/laser-safety

· I understand access restriction in Designated Laser Areas and the operation of door interlocks.

· I know the location and capabilities of laser safety equipment (safety glasses/goggles, beam dumps, gloves, etc.) in my laboratory.

· I have fully discussed the safety aspects of operating lasers in my particular experiment(s) with my research supervisor and we have agreed on a standard operating procedure.

LASER USER:

NAME …………………………………………... SIGNATURE: ..…………………………. DATE: ………………

ACADEMIC SUPERVISOR:

NAME …………………………………………... SIGNATURE: ..…………………………. DATE: ………………

DEPARTMENTAL LASER SAFETY OFFICER (if different from Academic Supervisor):

NAME …………………………………………... SIGNATURE: ..…………………………. DATE: ………………