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CEHS, Center for Environmental Health and Safety

Annual Laser Registration Form

Laser producing instruments on the SIUC campus are subject to registration requirements as regulated by the Illinois Department of Nuclear safety. All Class 3b and Class 4 lasers at SIUC must be registered annually at the Office of Radiological Control. The initial registration of laser instruments consists of completing the online registration form below. Each annual registration following the initial registration will be completed by email notification of the contact person listed. Please complete the following form to complete the initial laser registration.

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Instrument Information

Serial Number: 
SIU Property Control Number:
Manufacturer:
Model:
Description of Instrument:
Class:
Description of Instrument’s Use:
Emission Duration: Continuous  Pulse
Fixed or Mobile: Fixed  Mobile
Power Output:
Wavelength:

 

Location Information

Building:  
Room Number:  
Responsible Person:
Contact Person:
Contact Phone Number:
Contact Email Address:
Additional Comments/Questions:

Copyright © 1994-2003 Southern Illinois University
Center for Environmental Health and Safety
Phone: 618-453-7180
E-mail: info@cehs.siu.edu