LASER OPERATOR REGISTRATION FORM
Title: .......................... First Name(s): ...........................................................................
Surname: ........................................................ Date of Birth: .......................................
Gender: ....................... National Insurance No: ...........................................................
E-Mail: ..........................................................................................................................
School / College: ..........................................................................................................
Group: ........................................ Building: ...................................................................
Position: ....................................................... Class of Laser(s): ...................................
Have you been a designated laser operator in any previous employment?
YES/NO
Have you ever attended a formal course in laser safety?
YES/NO
If YES, please give details: .............................................................................................
Have you completed the Laser Safety Course via Moodle 2?
YES/NO
If NO, please contact Brian.McLaughlin@glasgow.ac.uk to be enrolled.
TO BE SIGNED BY THE PROSPECTIVE LASER OPERATOR:
I have read and understood the rules applicable to my type of work as laid down in
School/College Local Rules and Schemes of Work or any other literature produced by my
establishment relevant to the laser(s) I will be operating.
Signed: ...................................................................... Date: ...................................................
RADIATION PROTECTION SERVICE
The Kelvin Building, Glasgow G12 8QQ, Scotland
Radiation Protection Adviser: J M Gray BA (Hons) MSRP CRadP
E-Mail: James.Gray@glasgow.ac.uk
Telephone RPA & Office: 0141 330 4471 Fax: 0141 330 4805
The University of Glasgow, Charity No SC004401