UNIVERSITY OF MASSACHUSETTS LOWELL
Laser Audit Form
Location of Laser System: ______Name of Laser User: ______
Verified Laser User Training Complete: ______Date: ______
Laser permit authorization up to date: ______
Laser Class: ______OD: _____ Wavelength: ______nm
Laser Class: ______OD: _____ Wavelength: ______nm
Laser Class: ______OD: _____ Wavelength: ______nm
I. LASER POSTING, LABELING AND SECURITY MEASURES:
Y N N/A
Entrancewarning sign properly posted: Comments:______
Room security adequate: Comments: ______
Entryway protective barriers: ______
Door interlock system (defeatable/non-defeatable): Comments:______
Entryway protected control zone: Comments:______
Laser status indicator outside room: Comments: ______
II. EYEWEAR:
Y N N/A
Laser eye protection available: Comments: ______
Eyewear condition adequate: Comments: ______
OD / Pertinent wavelength / Qty. / OD / Pertinent wavelength / Qty.III. LASER UNIT SAFETY CONTROLS:
Y N N/A
Laser hazard and class label in place: Comments: ______
Laser aperture label in place: Comments: ______
Protective housing in place: Comments: ______
Laser not at eye level: Comments: ______
Key control should be present:Comments: ______
Laser activation indication on console:Comments: ______
IV. ENGINEERING SAFETY CONTROLS:
Y N N/A
Emergency shutoff available: Comments: ______
Laser and optics secured to table: Comments: ______
Reflective materials kept out of beam path: Comments: ______
Beam barriers in place and adequate: Comments: ______
Interlock present on embedded class 3B or 4 lasers______
Beam stops in place: Comments: ______
Windows in room covered: Comments: ______
No physical evidence of stray beams: Comments: ______
Optional Information
Beam condensed or enlarged: Comments: ______
Beam intensity reduced through filtration:Comments: ______
Fiber optics used: Comments: ______
Beam path is enclosed: Comments: ______
Beam shutter functioning: Comments: ______
Beam power meter: Comments: ______
V. ADMINISTRATIVE SAFETY CONTROLS:
Y N N/A
Emergency contact list up to date and posted: Comments: ______
Laser safety guidelines posted: Comments: ______
Laser safety policy manual available: Comments: ______Lab specific SOP’s up to date: Comments: ______
Lab specific Alignment procedures: Comments: ______
Proper skin protection is available (UV and >1400nm): Comments: ______
VI. NON-BEAM HAZARDS:
General housekeeping: (CLEAN, FAIR, MESSY)______
A YES response for the items below indicates that the hazard is handled safely:
Y N N/A
Fire hazards (Class 4 only): Comments: ______
LGAC production (Class 4 only): Comments: ______
Electrical shock: Comments: ______
Collateral radiation hazard (>15KV power supply): Comments:______
Explosion hazards: Comments: ______
Cryogen handling: Comments: ______
Compressed gases: Comments: ______
Toxic laser media: Comments: ______
Fume hood working: Comments: ______
VII. NEW LASER SYSTEM INFORMATION: Fill out only if new lasers are found.
Laser Type: CW Pulsed Laser Class: 3B 4
Manufacturer: ______Model: ______
Serial Number: ______
Wavelength: ______nm Output (max/used): ______W J
Beam Diameter at Aperture: ______mm Beam Divergence: ______mrad
Pulse Duration: ______sec Pulse Frequency: ______Hz
NOTES:______