UNIVERSITY OF FLORIDA
LASER USER
STATEMENT OF TRAINING AND EXPERIENCE
(To be completed by ALL personnel who will be working with Lasers)
NAME: __________________________ DEPARTMENT_____________________________

CLASSIFICATION (Faculty, Technician, Student, etc.):_________________________________

PRINCIPAL INVESTIGATOR:________________________________PHONE:_______________

ALL INDIVIDUALS MUST COMPLETE THE REMAINED OF THIS FORM

LASER SAFETY TRAINING

SUBJECT WHERE TRAINED DATES AND DURATION OF TRAINING PRECEPTOR/
ON THE JOB (Circle Answer)		 FORMAL COURSE (Circle Answer)
 
Fundamentals of Laser Operations                                     Yes                    
No		 Yes                 
No
 
Laser Classifications
 		                                     Yes                   
No		 Yes                 
No
 
Control Measures
 		                                     Yes                   
No		 Yes                 
No
 
Bioeffects of Laser Radiation Exposure                                     Yes                   
No		 Yes                 
No
 
Non-Radiation Hazards Associated with Lasers                                     Yes                   
No		 Yes                 
No
 
Investigator and User Rsponsibilities                                     Yes                   
No		 Yes                 
No

LASER USE EXPERIENCE

LASING MEDIUM LASER CLASS MAX OUTPUT POWER DATES AND DURATION OF EXPERIENCE WHERE EXPERIENCE WAS GAINED
 
         
 
         
 
         
 
         

 

SIGNATURE:___________________________________________ DATE:___________________

If additional space is needed, use the back of this sheet. Keep a copy and return original to:
RADIATION CONTROL DEPARTMENT -212 Nuclear Sciences Center - Box 118340

EHS/RC-1/REV1/94