Research Laser Registration Form Research Laser Registration Form LinkedInThis field is for validation purposes and should be left unchanged.Authorized User (Person Responsible for Device)Name of Authorized User* First Last Department:*Office Address:*Phone Number:*Email Address:* Name of Laser Lab ManagerSame as Authorized User Yes No Name of Laser Lab Manager* First Last Contacts Phone Number:*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 (Continuous Wave) Pulsed 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:This field is hidden when viewing the formLaser Safety TrainingThis field is hidden when viewing the form1-Name:This field is hidden when viewing the form1-Expected Training Completion Date: MM slash DD slash YYYY This field is hidden when viewing the form2-Name:This field is hidden when viewing the form2-Expected Training Completion Date: MM slash DD slash YYYY This field is hidden when viewing the formBaseline Eye Examination (For Class 3B or 4 Laser)This field is hidden when viewing the form1-Name:This field is hidden when viewing the form1-Expected Eye Examination Completion Date: MM slash DD slash YYYY This field is hidden when viewing the form2-Name:This field is hidden when viewing the form2-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