Rockwell Laser Industries
Laser Safety Products, Training and Consulting at Rockwell Laser Industries
My RLI Contact Us Contact Info

Laser Accident Report Form

Laser Accident Form

Report a Laser Accident

We have provided the form below so you can report any laser accidents for inclusion into our database. Any personal information will remain confidential and will be used only to verify specific detail with you directly.

Our goal is to keep the laser community informed, and by doing so, prevent similar events from occurring in their other facilities.

For more information about the reporting a laser accident, please contact us via email or call an RLI representative at (800) 94-LASER.

 

Laser Accident Report Form

  
Email Address:
  
Description of Accident :
 
  

Injury Type:

  




  

Eyewear Specifics:

  
 
  

Accident Type:

 
  

Environment:

  
 

Beam Hazard:

 
  

Non-Beam Hazard:

 
  

Optional Information:

  
Name:
Address:
Phone:
Fax: