Embedded Laser Safety Questionnaire Embedded Laser System Questionnaire CommentsThis 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?YesNoHas the laser system been modified, altered, or repaired by personnel other than the manufacturer's certified service technicians in the past 12 months?YesNoHave any components, protective housing, interlocks, or access panels been altered?YesNoSafety Features & ControlsAre all protective housings, covers, and enclosures intact and functioning as designed by the manufacturer?YesNoAre all safety interlocks operational and test periodically?YesNoAre status lights, labels, and indicators intact and visible?YesNoIncidents and MaintenanceHas any preventative maintenance been performed according to manufacturer reccommendations?YesNoNo laser safety injuries or exposures occurred during the past 12 months.YesNoNo safety interlock failures occurr4ed during the past 12 months.YesNoNo near misses or safety concerns occurred in the past 12 months?YesNoCompliance VerificationAre current operating procedures available to personnel?YesNoDoes the embedded laser system continue to meet conditions under ANSI Z136.1?YesNoAny planned changes in the next 12 months have been evaluated and are not expected to affect laser safety.YesNo