Please complete the initial laser registration below. Items marked with an asterick (*) are required for submission. You will receive a copy of your information once this form is successfully submitted.General InformationPI Name *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 UsagePlease describe the usage/experimental purpose of the laser or laser system (in layman's terms). *Laser InformationSource of Laser *New (purchase)New (donation)Used (donation)ExistingBuilt at UAManufacturer Model Serial Number Laser Class *11M22M3A3R3B4Type *ContinuousPulsedDescription (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 BeamFully EnclosedFiber DeliveryOtherIs a Laser warning sign posted on the door? *YesNoNot RequiredPlease 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. Fieldset VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
