RADIATION SAFETY CERTIFICATION CHECKLIST
CLASS 3B AND 4 LASER LABORATORY
Supervisor Name:
DRSO Name:
Inspection Team:
Department:
Building No:
Date:
Room No:
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
For laboratories using more than one (1) laser additional information can be supplied on the last page.
CRITERIA
Y
N
N/A
ACTIONS REQUIRED/COMMENTS
DRSO Arrangements
Does the budget division/department have a DRSO?
Is there a register kept for all class 3B or class 4 lasers?
Management
Is access to the Laboratory limited to authorised personnel?
Are appropriate laser warning signs displayed at the laboratory doors?
Are visible (and audible) signals if needed provided inside the laboratory
Have risk assessments been completed for all laser procedures?
Are standard operating procedures (SOP) in place for all laser activities?
Is an appropriate tag out system in place?
safety.unimelb.edu.au
RADIATION SAFETY CERTIFICATION CHECKLIST: CLASS 3B AND 4 LASER LABORATORY 1 of 4
Date: 23 September 2013 Version: 1.3 Authorised by: Director, OHS and Injury Management Next Review: 23 September 2016
© The University of Melbourne – Uncontrolled when printed.
CRITERIA
Y
N
N/A
ACTIONS REQUIRED/COMMENTS
Laboratory Practices
Are lasers regularly checked and maintained?
Have lasers got fixed signage to the plant and it complies with Standards?
Do enclosures have appropriate interlocks to prevent personnel from entering beam
areas when the beam is on??
Is appropriate PPE worn whilst undertaking laser activities?
Are "fail-to-safe" interlocks provided where necessary?
Is there an appropriate lockout system for each laser?
Is there an authorised users list?
Has a plant hazard assessment been conducted for laser plant and associated plant?
Training
Have personnel completed a laboratory induction?
Have personnel completed Radiation Safety Practices – Laser training?
Have personnel completed refresher Radiation Safety Practices – Laser training?
Are there any additional training requirements? If “yes” have personnel completed
these?
Incident Reporting and Emergency Procedures
Are appropriate emergency procedures in place?
Are personnel aware of the required emergency procedures?
Are personnel aware of required incident reporting procedures?
Health Monitoring
Have personnel had a Laser Eye Examination?
Have personnel had ongoing scheduled Laser Eye Examinations?
safety.unimelb.edu.au
RADIATION SAFETY CERTIFICATION CHECKLIST: CLASS 3B AND 4 LASER LABORATORY 2 of 4
Date: 23 September 2013 Version: 1.3 Authorised by: Director, OHS and Injury Management Next Review: 23 September 2016
© The University of Melbourne – Uncontrolled when printed.
FURTHER COMMENTS/OBSERVATIONS
CLASS 3B AND CLASS 4 RADIATION LABORATORY CERTIFICATION APPROVAL
Y
N
Further Requirements/Comments
Follow Up/Action Date
Certification approved
Certification approved
(where further action was required and completed)
Verified on Management Licence
Name of Certifier:
Signature:
This certification is valid for
safety.unimelb.edu.au
Date:
year(s) from the date of approval
RADIATION SAFETY CERTIFICATION CHECKLIST: CLASS 3B AND 4 LASER LABORATORY 3 of 4
Date: 23 September 2013 Version: 1.3 Authorised by: Director, OHS and Injury Management Next Review: 23 September 2016
© The University of Melbourne – Uncontrolled when printed.
ADDITIONAL LASERS
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
Laser is being used for the following purpose(s):
Class of laser:
Wavelength of output:
Pulsed or continuous wave
Power output/exposure time:
Pulse energy rate/duration of light:
safety.unimelb.edu.au
RADIATION SAFETY CERTIFICATION CHECKLIST: CLASS 3B AND 4 LASER LABORATORY 4 of 4
Date: 23 September 2013 Version: 1.3 Authorised by: Director, OHS and Injury Management Next Review: 23 September 2016
© The University of Melbourne – Uncontrolled when printed.