Embedded Laser Safety Questionnaire Embedded Laser System Questionnaire InstagramThis field is for validation purposes and should be left unchanged.Principle Investigator Contact Info:Name First Last Email Location (Building & Room Number)Laser Device InformationManufacturerModel NumberLocation (Building & Room Number)Device Status & ConfigurationHas the laser system been used in the past 12 months?(Required)Select OneYesNoHas the laser system been modified, altered, or repaired by personnel other than the manufacturer's certified service technicians in the past 12 months?(Required)Select OneYesNoHave any components, protective housing, interlocks, or access panels been altered?(Required)Select OneYesNoSafety Features & ControlsAre all protective housings, covers, and enclosures intact and functioning as designed by the manufacturer?(Required)Select OneYesNoAre all safety interlocks operational and test periodically?(Required)Select OneYesNoAre status lights, labels, and indicators intact and visible?(Required)Select OneYesNoIncidents and MaintenanceHas any preventative maintenance been performed according to manufacturer reccommendations?(Required)Select OneYesNoNo laser safety injuries or exposures occurred during the past 12 months.(Required)Select OneYesNoNo safety interlock failures occurr4ed during the past 12 months.(Required)Select OneYesNoNo near misses or safety concerns occurred in the past 12 months?(Required)Select OneYesNoCompliance VerificationAre current operating procedures available to personnel?(Required)Select OneYesNoDoes the embedded laser system continue to meet conditions under ANSI Z136.1?(Required)Select OneYesNoAny planned changes in the next 12 months have been evaluated and are not expected to affect laser safety.(Required)Select OneYesNo