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
- 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.)
- 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.
- 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.
- 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:
- Fill in Part A of the form.
- 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.)
- 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
Dr. Lewis Roberts
East End Eye Associates
669 Whiskey Road
Ridge, NY 11961
631-744-8020