Laser Safety Permit Modification and Renewal form

Add/Remove Authorized Users

*Does not apply to Reduced Requirements Laser Safety Permits

To add authorized users, the following information is required:

  • Personnel Name, Position, ID#, E-Mail

To remove authorized users, just the name is sufficient.

Ex: Add: Jane Doe, Graduate Student, #123 456 789, Jane.Doe [at] 
or: Remove Jane Doe

To Add/Remove Laser Equipment

To add laser equipment the following information is required:

  • Serial #, Model #, Manufacturer, Location (Room and Building), Laser Hazard Class, Enclosed Status, Maximum Output Power, Wavelength(s), Pulse Duration (if applicable), Initial Beam Diameter, Laser Type, Application
  • To remove laser equipment, serial number, wavelength, and output power are sufficient.

Ex: Add: SN: T001, Model: Q1-ABC, Lasers Inc., Rm: 41-2, 3610 McTavish Street (EHS Building), Class IIIB, Embedded, 500mW, 600-800nm, No Pulse (continuous wave), 3mm, Diode Laser, Microscopy
or: Remove SN: T0005, 1064nm, 5W

To Renew a Permit and Make no Changes

To renew an expiring permit but make no changes, please include:

  • Renewing for the year 20XX, no changes to permit operating conditions.

To modify or renew your permit, fill in the appropriate information and then the LSO will contact you.


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