Laser Safety Compliance Checklist Form
Complete this checklist to assess compliance with laser safety protocols during operational inspections.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Laser Equipment Labeling
*
All equipment properly labeled
Some equipment missing labels
No equipment labeled
Protective Eyewear Availability
*
Available and worn by all personnel
Available but not consistently worn
Not available
Warning Signs and Area Controls
*
All warning signs and controls in place
Some missing or inadequate
None present
Laser Safety Training Status
*
All personnel trained and records up to date
Some personnel lacking training or records
No training records available
Operational Procedures Compliance
*
1
2
3
4
5
Emergency Procedures and Equipment
*
Procedures and equipment fully accessible and functional
Some deficiencies noted
No procedures or equipment available
Maintenance and Inspection Records
*
Records complete and up to date
Some records missing or outdated
No records available
General Housekeeping and Area Cleanliness
*
1
2
3
4
5
Additional Comments or Observations
Submit Checklist
Should be Empty: