Appendix A: ACTIVITY HAZARD DOCUMENT (AHD)
Outline for Class 3b & Class 4 Laser Users

GENERAL INFORMATION


TITLE

LOCATION
Bldg.-Room


DIVISION


LASER SAFETY CONTACT




 

DESCRIPTION OF ACTIVITY

Provide description including unique equipment, its application or activity and principal parameters.

 

DURATION (Check One Box)

 

p Ongoing

 

 

p Limited Period; Enter # of Months _____

 

 

IDENTIFICATION OF HAZARDS

 

p Laser p Other (Please explain in space provided below)

 

 

p Toxic Gases

 

 

p Electrical

 

 

p Radioactive Materials

 

 

p Toxic Chemicals

 

 

MITIGATION OF HAZARDS

Controls to reduce the potential hazards. From a laser perspective, the following needs need to be addressed:

Identification of laser(s): Laser specifications

Complete the following chart (as much as possible), list all lasers, including low power alignment lasers:
 

Laser 1

Laser 2

Laser 3

Type:


Manufacturer:


Model:


Serial #


Maximum Power


Wavelength Range


Wavelength Used


Power Used


Pulse Length


Pulse Repetition Rate


Beam Diameter


Beam Divergence


Property #


Made In-House


Class


 

LASER USERS



Employee

Date
Laser Safety Training
Completed

Date
Eye Examination
Completed









 

ATTACH A DIAGRAM OF LASER USE AREA (A simple block diagram is sufficient. The diagram should also be posted on lab door.)

 

DESCRIBE ACCESS CONTROLS, INCLUDING USE OF INTERLOCKS

 

DESCRIBE ALIGNMENT PROCEDURES

 

WHERE HAVE LASER WARNING SIGNS BEEN POSTED?

(Warning signs can be obtained from LBNL-LSO or Campus LSO)

 

PROTECTIVE EYEWEAR

Number of
Pairs
on Hand



Location of Eyewear



Manufacturer



Optical Density



Wavelength










 

BEAM PATH – Open, Enclosed, or Partially Enclosed

 

NONBEAM HAZARDS (Include non-laser items identified as hazards)

HAZARD

CORRECTIVE ACTION








 

MAINTENANCE

Equipment will be maintained in accordance with PUB-3122, Maintenance Program guidelines for Programmatic Equipment. System safety devices will be tested and documented in accordance with PUB-3000, Health and Safety Manual. Accurate records will be kept of tests, calibrations, adjustments, and repairs done. The door interlock will be checked quarterly and a record kept.

EMERGENCY PROCEDURES

Authorized laser users will be familiar with the Building Emergency Plan, location of emergency equipment, and emergency procedures for fires, earthquakes, and evacuations. Emergency shut-off procedures for lasers consist of shutting off the electrical power to the laser system. The main electrical shut-off switches to the laser should be labeled.

ANNUAL REVIEW SCHEDULE

If new hazards have been introduced, a full EH&S review will be required one year from approval date. If no changes other than users have been made (an update of the users list will be sent to LSO) renewal can be granted by user’s division safety coordinator.


Previous Chapter Back to the chapter