Research Laser Registration Form Research Laser Registration Form Name of Authorized User (Person Responsible for Device)* First Last Department:* Office Address:* Phone Number:* Email Address:* Name of Laser Lab Manager* First Last Contacts Phone Number:*Contacts Email Address:* Laser SystemMFR/Model Number:* Serial Number:* Laser Location ( building & room )* Laser Type (e.g. Nd:YAG):* Laser Class:* Details (If Embedded Laser) Laser Operating ParametersMode (CW/Pulsed/ Q-Switch):* CW Power Output (W):* Energy Output (J):* Wavelength (nm):* Pulse Length (s): Pulse Repetition Rate (Hz): Beam Diameter (mm): Beam Divergence: Laser EyewearWavelength Attenuated (nm): Optical Density (OD): Quantity: Manufacturer: Laser Safety Training1-Name: 1-Expected Training Completion Date: MM slash DD slash YYYY 2-Name: 2-Expected Training Completion Date: MM slash DD slash YYYY 3-Name: 3-Expected Training Completion Date: MM slash DD slash YYYY Baseline Eye Examination (For Class 3B or 4 Laser)1-Name: 1-Expected Eye Examination Completion Date: MM slash DD slash YYYY 2-Name: 2-Expected Eye Examination Completion Date: MM slash DD slash YYYY 3-Name: 3-Expected Eye Examination Completion Date: MM slash DD slash YYYY Laser Operation ProceduresAttach Procedure Here: Drop files here or Select files Max. file size: 64 MB. Date Operating Procedures Available: MM slash DD slash YYYY Signature:* Date:* MM slash DD slash YYYY