Laser System Qualification

There are multiple laser systems at the CFN. Users who will be working with the following class 3B or 4 laser systems are required to complete the Laser Safety (TQ-LASER) training and comply with Occupational Medical Clinic (OMC) Laser Medical Surveillance:

• Amplified Ti:Sapphire Laser System,
  Advanced Optical Spectroscopy and Microscopy Facility, Room 1L01A
• Time Correlated Single Photon Counting Spectroscopy and Microscopy,
  Advanced Optical Spectroscopy and Microscopy Facility, Room 1L01C

Laser Medical Surveillance Form

The purpose of the Laser Medical Surveillance form is to provide BNL-OMC with information necessary to determine that an individual to be cleared as a laser user at BNL has met the medical requirements of ANSI Standard Z136.1-2007 governing the safe use of lasers.

This standard requires each Class 3B and 4 laser user to have a pre-assignment eye examination by an ophthalmologist, which is recorded on Part B of the Laser Medical Surveillance form.

Download Laser Form

Instructions to Laser Users

1. As soon as possible, contact one of the contracted local ophthalmologists from the list below and request an appointment for a “laser eye exam for Brookhaven Lab.” (Note: You may also obtain this exam from a Board Certified ophthalmologist other than those listed. However, for BNL employees, BNL cannot guarantee payment. Consult with your BNL supervisor to discuss payment issues.)
2. Complete Part A of the form. This provides BNL-OMC with needed contact and medical information. The ophthalmologist will record his/her examination on Part B.
3. The ophthalmologist will then fax the form to BNL-OMC at (631)344-7366. This is a secure, clinic fax that can receive confidential medical information. BNL-OMC’s voice number for problems or questions is (631)344-3670. If unable to fax, mail as soon as possible to BNL-OMC at Brookhaven National Laboratory, Building 490, Upton, NY 11973.
4. After receipt of the form, BNL-OMC will contact the user if additional information or a skin examination is required.

A laser user who has already had a laser eye exam can submit this exam to BNL-OMC in lieu of a new laser eye exam. BNL-OMC will then consider whether the submitted exam is acceptable, or whether a new exam will still be required. Generally, to be acceptable, the submitted exam must

• be performed by a Board Certified ophthalmologist;
• provide substantially the same information that is requested in Part B of the attached form;
• have been performed within the last 3 years, with no laser eye accidents or changes in vision subsequent to the exam.

The laser user who wishes to submit a recent laser eye exam for consideration by BNL-OMC must do the following:

1. Fill in Part A of the form.
2. Fax Part A of the form to BNL-OMC at (631)344-7366, along with the written record of the laser eye exam. (If unable to fax, mail as soon as possible to BNL C at Occupational Medicine Clinic, Brookhaven National Laboratory, Bldg. 490, Upton, NY 11973-5000.)
3. BNL-OMC will contact the laser user if additional information or examinations are required.

Contracted Local Ophthalmologists

Dr. Charles Rothberg
331 East Main
Patchogue, NY 11772
631-758-5300