LASER REGISTRATION FORM

Instructions: All Class 3b and 4 lasers are required to be registered with the DU/DUMC Laser Safety Officer. Complete this form for each laser to be registered and click the "E-mail This Form" button at the bottom of the page. The data will be automatically sent to the Laser Safety Officer. The contents of the form and return e-mail addresses are confidential. The form can be cleared by clicking the "Reset Form" button.

Principal Investigator: Phone:

Laser Manufacturer:
Model Number:
Serial Number:
Duke ID Number:

Laser Location:

Building:
Department:
Room Number:

Laser Type (Nd:YAG, etc):
Classification (3b or 4):

Optical Characteristics:

Wavelength (nm):
Beam Diameter (mm):
Beam Divergence (mrad):

Mode:

Continuous Wave Avg. Power (watts):
Pulsed Joules/pulse: Repetition Freq:
Q-Switched Pulse Width: Joules/Pulse:

Purpose or Use:

Comments:

Date: