LASER PURCHASE REQUEST FORM

All purchases of lasers or laser systems must be approved by OEHS. This form must be completed and submitted to the Office of Environmental Health and Safety. Without this form, the LSO cannot approve any laser purchases.

CAMPUS:__________________________ BUILDING:__________________________________

ROOM #:__________________________ DEPT:_______________________________________

LASER MANUFACTURER:_______________________________________________________________

LASER MODEL:_____________________ LASING MEDIUM: ___________________________

OUTPUT (WATTS):__________________ WAVELENGTH/RANGE:_______________________

CLASS (I-IV):_______________________

PRINCIPAL OPERATOR:___________________ DATE OF SUBMITTAL:________________________

PHONE ________________________________ EMAIL ______________________________________

DEPARTMENT HEAD:___________________________________________________________________

After completing the form, mail to OEHS - TW16 or fax to 504-988-1693.