
Energy J or Max Power W Class Use Type 3b Human Non-human If Human Use List Medical Procedures Use Location Laser Owner if not the PA Number of CONTINUATION SHEETS attached S /RAD/wrd/LASER/PERMIT rev 050909. Doc CONTINUATION SHEET SECTION 3 continued Name Print PERMISSION TO USE LASER S Signature of Laser Registrant/Owner if not the Permit Administrator Training and Experience Please attach SUPPLEMENT A for Non-human Use. Section 3 To be used if.
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How to fill out the UTMB application for laser use permit online
The UTMB Application for Laser Use Permit is an essential document for anyone looking to utilize laser technology in their work. This guide provides a clear and supportive walkthrough for filling out the application online, ensuring you understand each component effectively.
Follow the steps to successfully complete the application online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by completing Section 1, which includes information about the permit administrator. Provide the name, title, department, office location, mail route, phone number, and email of the administrator.
- In Section 2, indicate whether this application is for a new permit, an amendment, or a renewal. If applicable, list any changes to the previous permit.
- Proceed to Section 3 to list all authorized laser users. Include their names and the specific laser models they will be using.
- Section 4 is focused on the lasers themselves. Enter details such as the manufacturer, model, laser media, wavelength, maximum energy or power, and class of each laser. Specify the location of use and, if the owner is not the permit administrator, include their name.
- If additional authorized users or lasers are needed, use the continuation sheets provided. Number these accordingly.
- In Section 5, detail the training and experience of the users. Attach Supplement A for non-human use or Supplements B and C for human use.
- Attach Supplement D in Section 6, which should include a facility diagram indicating where the lasers will be used.
- For Section 7, provide a copy of the operating procedures as developed by the department or manufacturer.
- In Section 8, attach emergency procedures that outline what to do in the event of a laser-related emergency.
- Section 9 requires signatures from the laser registrant or owner for permission to use the lasers.
- In Section 10, the applicant must certify that all information is correct by providing their signature, printed name, and date.
- Finally, Section 11 includes areas for recommendation signatures from the permit administrator and department head.
- Once all sections are completed, save changes, download, print, or share the document as necessary.
Start completing your UTMB Application for Laser Use Permit online today.
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Does UTMB have a secondary application?
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