Laser Safety Release Form
From Physics 111-Lab Wiki
All pages in this lab
I. Holography
II. Staff Sign-Off Sheet (HOL)
III. Hologram Development Procedures
IV. Optical Tutorial
VII. Laser Safety Release Form
Training Certification Document for the Office of Radiation Safety
Subject: (Laser User and Laser Registration)
Name of Laser User (Print):
Last First Middle
Student ID \# :
Name of Principal Investigator: Orlando Donald J.
Last First Middle
LUR Numbers: 1188 & 1189 & 1190 Phone No: 642-5328 Room: 282 LeConte Hall
Laboratory Location: Physics 111-LAB Room No.:
Type of 'Laser, Power, & ? ':
I the undersigned have read and understood the UCB Laser Safety Training Supplement and Laser Use Registration (LUR). I have received instruction from the Principal Investigator (or his/her designee) in the use of the laser systems, associated optics, and laser safety standards and laboratory Standard Operating Procedures, (SOP's) and that I am responsible for my own safety in the laboratory.
(Signed): Dated:
Social Security \# :
I the undersigned have viewed the Laser Safety Video in the Physics 111-LAB and read the training manual.
(Signed)
Date Read & Viewed:
Staff Signature:
