Form AC 7140-1 AC 7140-1 Notice of Proposed Outdoor Laser Operations(s)

U.S. Department
of Transportation
Federal Aviation
Administration

FAA Form 2120-0662, Notice of Proposed Outdoor Laser Operation(s)

Paperwork Reduction Act Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with a collection of information subject to the requirements of the
Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The
OMB Control Number for this information collection is 2120-0662. Public reporting for this collection of
information is estimated to be approximately 4 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, completing and reviewing the
collection of information. All responses to this collection of information are required under 49 U.S.C. Section 47105
to retain a benefit and to meet the reporting requirements of 2 CFR 200; no assurance of confidentiality is
provided. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591,
Attn: Information Collection Clearance Officer, ASP-110.

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Form Approved OMB No 2120-0662
Expiration Date: xx/xx/xxxx

Please print or type on this form. Failure to provide all requested information may delay processing of your notice.

This area for FAA use only

U.S. Department of Transportation
Federal Aviation Administration

NOTICE OF PROPOSED OUTDOOR LASER OPERATION(S)

1. GENERAL INFORMATION
(a) To: (FAA Service Center)

(b) From: (Proponent)

(c) Event or facility

(d) Report date

(e) Customer

(f) Site address

2. DATE(S) AND TIME(S) OF LASER OPERATION
(a) Testing and alignment

(b) Operation

3. BRIEF DESCRIPTION OF OPERATION

Check box if all beams are terminated

4. ON-SITE OPERATION INFORMATION
(a) Operator(s)

(b) On-site phone #1

(c) On-site phone #2

5. FDA CDRH LASER LIGHT SHOW VARIANCE (if applicable)
(a) Variance #

(b) Accession #

(c) Expiration date

6. BRIEF DESCRIPTION OF CONTROL MEASURES

7. ATTACHMENTS
(a) Number of laser configurations

Fill out one copy of page 2 of this Notice (e.g., items 10-15 on the next page) for each configuration

(b) List additional attachments (including maps, diagrams, details of control measures, and details of calculations or software printouts)

8. DESIGNATED CONTACT PERSON (if further information is needed)
(a) Name

(c) Phone

(b) Position

(d) Fax

(e) E-mail

9. STATEMENT OF ACCURACY
To the best of my knowledge, the information provided in this Notice (both sides) and the attachment(s) is accurate and correct
(a) Name (if different from contact person)

(b) Position

(c) Signature

(d) Date

FAA Form 7140-1
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Form Approved OMB No 2120-0662
Expiration Date: xx/xx/xxxx
Please print or type on this form. Failure to provide all requested information may delay processing of your notice.
This area for FAA use only
10. CONFIGURATION INFORMATION
(a) Configuration number ______ of _______

(b) Name of event/facility

(c) Report date

(d) Brief description of configuration

11. GEOGRAPHIC LOCATION
(a) Site elevation (Mean Sea Level), in feet: __________
(b) Laser height above site elevation (above ground level), in feet:

(e) Latitude:

__________

(c) Overall laser elevation (a) + (b), in feet: __________ Mean Sea Level
(d) Latitude and longitude determined by:

☐GPS ☐ Map (quad) ☐Other

(f) Longitude:

_______ degrees, _______minutes, _______seconds
_______degrees, _______minutes, _______seconds
☐NAD 27 ☐ NAD 88
☐NGVD 29 ☐NAVD 88

(g) Horizontal datum:
(h) Vertical datum:

12. BEAM CHARACTERISTICS AND CALCULATIONS (check one Mode of Operation only, and fill in only that column)
MODE OF OPERATION

☐SINGLE PULSE

☐CONTINUOUS WAVE

☐REPETITIVELY PULSED

Maximum Power

Average Power

12(a) LASER AND BEAM CHARACTERISTICS
Laser type
(example: DPSS, sodium-vapor, etc.)
Laser classification
(examples: 1,2,3,4)
Power
Watts (W)

(not applicable)

Pulse energy
Joules (J)
Pulse duration
Seconds (s)
Pulse repetition frequency
Hertz (Hz)

(not applicable)
(not applicable)
(not applicable)

Beam diameter at 1/e points
Centimeters (cm)
Beam divergence 1/e at full angle
Milliradians (mrad)
Wavelength(s)
Nanometers (nm)
12(b) MAXIMUM PERMISSIBLE EXPOSURE (MPE) VALUE (this will be used to calculate the NOHD)
MPE
Watts per square cm (W/cm2)

(not applicable)

MPE per pulse
(not applicable)
Joules per square cm (J/cm2)
12(c) VISUAL EFFECT CALCULATIONS
The following items are for lasers with visible wavelengths (400-700 nm). If the laser has no visible wavelengths, enter “N/A (non-visible laser)” in all blocks.
Pulse Energy (J) x 4
Maximum Power (from above)
Pulse Energy (J) x PRF (Hz), or Average Power
Pre-Corrected Power (PCP)
Watts (W)
Visual Correction Factor (VCF)
Enter “1.0” or use Table 3
Visually Corrected Power
PCP x VCF
13. BEAM DIRECTION(S)
(a) Maximum elevation angle (degrees)

(c) Magnetic variation (degrees)

(b) Minimum elevation angle (degrees, where horizontal = 0 degrees)

(d) Azimuth (degrees)

☐True ☐ Magnetic

14. PROTECTION DISTANCES (fill in all three columns below)
SLANT RANGE (ft)

HORIZONTAL DISTANCE (ft)

VERTICAL DISTANCE (ft)

(a) NOHD (based on MPE value)
The following items are for lasers with visible wavelengths (400-700 nm). If the laser has no visible wavelengths, enter “N/A (non-visible laser)” in all blocks.
(b) SZED (for 100 µW/cm2)
2
(c) CZED (for 5 µW/cm )

(d) LFED (for 50 nW/cm2)
15. CALCULATION METHOD

☐Commercial software (print product name)

☐Other (describe method such as spreadsheet, calculator, etc.)
FAA Form 7140-1
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