BOSTON UNIVERSITY LASER SYSTEM DISPOSAL REQUEST
Permit Name: _______________________ Location:__________ Room: ________
Phone number: ______________________ email: _____________________
Please complete the following information and email to kurk@bu.edu
Laser Manufacturer: ________________________________________________
Serial No. (s): _____________________________________________________
BU ID Tag (if assigned): _____________________________________________
For Disposal: ______________________________________________________
Laser Classification (circle): Class 1
2M
2R
3M
3B
4
Laser Medium: ________________________ Wavelengths: ___________________
Maximum Laser Output: ____________________________
Pulsed Duration: _________________________________
Once the decision has been made to dispose of a Laser System the following actions must be
taken prior to the actual Disposal:
1) Review the manufactures laser system manual for “CAUTION” statement that will
specify associated hazards.
2) Completely disable the laser from ever operating again. Eliminate the possibility of
activating the laser by removing all means by which it can be electrically activated.
Remove the power cord and switches.
3) Impair the laser hardware.
4) Remove any hazardous substances such as Mercury switches, Batteries, Dyes,
Oils, Solvents, biological, chemicals, radioactivity, etc., and wherever possible recycle
them.
5) Remove and separately recycle any Laser Diodes or BeO Plasma Tubes from the laser.
6) Recycle whatever remains of the Laser.
7) Notify the LSO to have the Laser removed from Inventory.
8) Decontaminate laser with the surfaces of the equipment have been decontaminated (if
equipment: inside and outside) with: (specify decontaminants and percentages, (i.e.70%
Ethanol, if 10% bleach is used, it must be freshly made up).
9) Obtain GREEN STICKER for final disposal.
_______________________________________
______________
Signature of Principle Investigator/Permit Holder:
Date
_________________________________________________________________
LSO: Laser Inspected on:
Disposal approved:
Disposal disapproved:
LSO signature:
Date:
Ma-DPH contacted to amend inventory: Date___________________