APPENDIX K

APPLICATION FOR THE NON-HUMAN USE OF LASERS
TO THE RADIATION CONTROL COMMITTEE

  1. Principal Investigator: _____________________________________________________
     
    Department: _____________________________________________________
     
    Office Room Number: ______________     Phone Number: ______________________
     
    Lab Technician: ___________________    Phone Number: ______________________
  2. Authorized user(s):                                 Job Title:
     
    _____________________________    _________________________________
     
    _____________________________    _________________________________
     
    _____________________________    _________________________________
     
    _____________________________    _________________________________
  3. Information regarding the Principal Investigator and authorized user(s) basic training with laser shall be forwarded to the Radiation Control Office at the time this proposal is submitted. Forms for submitting this information (RC-1L) are available from the Radiation Control Office, phone 293-7359.
  4. Inventory of Lasers: (use attached form)
  5. Describe the procedures for which the laser will be used. Submit any locally generated standard operating procedures and safety instructions and confirm that an operator's manual is available at the unit. If factory installed safety interlocks must be bypassed during any use of the equipment, submit justification for bypassing the interlock.
  6. Describe the facility in which the device will be used.
  7. Briefly describe personnel safety equipment available.

Return original to the:

RADIATION CONTROL OFFICE
212 Nuclear Sciences Center / Box 118340