Initial Laser Registration

Initial Laser Registration

Please complete the initial laser registration below. Items marked with an asterisk(*) are required for submission. You will receive a copy of your information once this form is successfully submitted.

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General Information

PI Name *

First

Last

Email *

Campus Phone *

Cell Phone (in case of emergency) *

Office Location

Laser Usage Location *

Laser Storage Location (if different from usage)

Please list the people who will be using the laser or laser system.

Please list the people who will be working in the area of the laser or laser system but are NOT users.

Laser Usage

Please describe the usage/experimental purpose of the laser or laser system (in layman's terms). *

Laser Information

Source of Laser *

• New (purchase)
• New (donation)
• Used (donation)
• Existing
• Built at UA

Manufacturer

Model

Serial Number

Laser Class *

• 1
• 1M
• 2
• 2M
• 3A
• 3R
• 3B
• 4

Type *

• Continuous
• Pulsed

Description *

(HeNe, Nd-YAG, etc.)

Wavelength(s) *

Maximum Power/Peak Power (Watts or Joules) *

Pulse Duration

Emerging Beam Dimensions (mm)

Beam Divergence (mm)

Laser Safety (General)

Laser Setup *

• Open Beam
• Fully Enclosed
• Fiber Delivery
• Other

Is a Laser warning sign posted on the door *

• Yes
• No
• Not Required

Please list the type of laser eyewear available, including optical density and storage location. If not needed, please enter "NA". *

Please provide information for alignment and service, including who will perform these functions. If not needed, please enter "NA". *

Please include any additional information, questions or comments below.

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