Instructions:

Answer all questions

Complete this form electronically & save as:

<LAU_PI name of the Lab providing access to the laser>, e.g., <LAU-GSmith>

Use the mouse, tab, or scroll (page up/down arrows will not work)

Submit the electronic documents to linspec@emory.edu

Responsibilities for the PIs designated as the PI of the Lab given access to the laser and PI of the Lab providing access to the laser:

The PI of the Lab given access to the laser will ensure that the following measures are in place in the laser work area:

Laser work area has been reviewed and approved for laser use by EHSO

Appropriate laser protective eye wear for the specific laser(s) shall be used (as determined by EHSO)

Laser protective eyewear

Can be obtained from the PI of lab providing access to the laser, or

Can be purchased from a vendor, as long as it meets EHSO’s requirements.

All necessary signage is in place for the use of lasers

Any additional control measures prescribed by EHSO shall be followed

All individuals using the laser have been adequately trained as follows:

All individuals using the laser have been trained on the operation of the laser (SOP);

All individuals using the laser have obtained General Laser Safety training via Emory Learning Management System (ELMS). An assessment is incorporated into the course, which must be passed with a score of 80% or higher; and

All individuals using the laser have reviewed the Laser Safety Manual (available at www.ehso.emory.edu)

Prior to being granted access to the laser, the PI of the Lab given access to the laser must ensure Attachment 1 has been completed by both parties and must keep a copy of Attachment 1 in their lab records.

The PI of the Lab providing access to the laser:

Prior to granting access to the laser, the PI must obtain confirmation from the PI of the lab given access to the laser and EHSO of items 1.a – e above

Prior to granting access to the laser, the PI must ensure that granting access to another lab/PI does not violate the terms of any granting agency, foundation, or other group or individual responsible for funding the purchase of the laser.

Transfers liability of the laser and laser operations during the access period to the PI of the Lab providing access to the laser during the designated period

Prior to granting access to the laser, the PI of the Lab providing access to the laser shall notify the Emory Laser Safety Committee of the plan. This can be accomplished by providing this completed form to EHSO.

Prior to granting access to the laser, the PI of the Lab providing access to the laser must ensure Attachment 1 has been completed by both parties and must keep a copy of Attachment 1 in their lab records.

Description of Laser Equipment Access

The Laser Equipment (dates and times for the laser access and usage are determined in advance)

SN:
Manufacturer:
Wavelength:
Active Medium:
Date of Laser arrival:
Date of Laser return:
Location: Address, Building, Room#

Acknowledgement

The PI of the Recipient Lab is responsible for compliance with all safety of use during the loan period, as well as the proper function and return of the device.

PI of the Lab given access to the laser:

PI name: __ ___________________________

PI Signature:	Date:

By manually signing this form or printing my name electronically, I acknowledge that all statements are true and accurate. If requested, an actual signed document can and will be provided.

PI of the Lab providing access to the laser:

PI name: __ ___________________________

PI Signature:	Date:

By manually signing this form or printing my name electronically, I acknowledge that all statements are true and accurate. If requested, an actual signed document can and will be provided.