Laser Safety Assessment Form
Evaluate laser safety readiness and operational controls at your worksite or facility. Please complete all sections accurately.
Type of Facility/Worksite
*
Please Select
Research Laboratory
Manufacturing Site
Medical Facility
Educational Institution
Other
Are all laser devices properly labeled and classified according to standards?
*
Yes
No
Not Sure
How would you rate the visibility and condition of laser warning signs in the facility?
*
1
2
3
4
5
Is appropriate personal protective equipment (PPE) available and in use during laser operations?
*
Always
Sometimes
Never
Laser Safety Controls Assessment
*
Rows
Not Present
Partially Present
Fully Present
Beam Enclosure
1
2
3
Key Control/Access Restriction
4
5
6
Emergency Shutoff
7
8
9
Interlocks
10
11
12
Standard Operating Procedures
13
14
15
Are emergency procedures for laser incidents clearly posted and accessible?
*
Yes
No
Not Sure
How often is laser safety training provided to staff?
*
Annually
Every 2 Years
On Hire Only
Not Provided
Rate the overall effectiveness of the current laser safety program.
*
1
2
3
4
5
Are there any known incidents or near-misses involving lasers in the past year?
*
Yes
No
Not Sure
Additional Comments or Observations
Submit Assessment
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