FDA 3640 Reporting Guide for Laser Light Shows and Displays

Form Approved: OMB No. 0910-0025
Expiration Date: January 31, 2017

FORM FDA 3640 (8/16)
Reporting Guide for Laser Light Shows and Displays

Public reporting burden for this collection of information is estimated to average 24 hours per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:
Department of Health and Human Services
Food and Drug Administration
Office of Operations
Paper Reduction Act (PRA) Staff
[email protected]
*Please do NOT send your completed document to this PRA Staff email address.*
An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number.

This guidance was written prior to the February 27, 1997 implementation of FDA’s
Good Guidance Practices, GGP’s. It does not create or confer rights for or on any person
and does not operate to bind FDA or the public. An alternative approach may be used if
such approach satisfies the requirements of the applicable statute, regulations, or both.
This guidance will be updated in the next revision to include the standard elements of GGP’s.

More industry guidance and assistance can be found at the FDA homepage, see:
http://www.fda.gov/Radiation-EmittingProducts/.

Send your completed report to:
CENTER FOR DEVICES AND RADIOLOGICAL HEALTH
DOCUMENT MAIL CENTER – WO66-G609
ATTN: ELECTRONIC PRODUCT REPORTS
10903 NEW HAMPSHIRE AVENUE
SILVER SPRING, MD 20993-0002
Questions about reporting and suggestions for changes to this guide may be sent to the above
address or may be discussed by calling 1-800-638-2041.

FORM FDA 3640 (8/16)

Reporting Guide for
Laser Light Shows and Displays
(21 CFR 1002)

Office of Compliance
September 1995

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
Center for Devices and Radiological Health
Silver Spring, MD 20993

FORM FDA 3640 (8/16)

This page is deliberately blank.

FORM FDA 3640 (8/16)

Foreword
The Office of Compliance, Center for Devices and Radiological Health (CDRH) developed this guide. This guide will
assist manufacturers¹ of electronic products which emit radiation in providing adequate reporting of radiation safety testing
and compliance with federal performance standards. Title 21 of the Code of Federal Regulations (CFR), Parts 1002 and
1003 specify Reporting and Notification requirements²,³.
Reports submitted on radiation safety of electronic products must follow the appropriate guide (21 CFR 1002.7). If the
report does not follow an applicable guide it must contain a sufficient justification for any deviations. The submitter of
the report will receive an acknowledgment letter with the accession number we assign to the report. Please reference this
accession number in the future when providing additional information about this model family in either a supplement or the
annual report. If a report is incomplete or inadequate CDRH may reject it and return it for completion. CDRH will not
enter a rejected report into our database. Also, a rejected report will not receive an accession number.
WE DO NOT APPROVE THESE REPORTS OR THE PRODUCTS BEING REPORTED. It is the manufacturer’s
responsibility to certify that their products comply with all applicable standards (21 CFR 1010 - 1050), based on a testing
program in accordance with good manufacturing practices. Prior to the shipment of products in interstate commerce
21 CFR 1002 requires the manufacturer to submit the report and to comply with all applicable importation requirements
(21 CFR 1005). If there are deficiencies, we may disapprove the firm’s quality control and testing program, determine
that the product contains a radiation defect, or determine that the product fails to comply with a standard. We will notify
the manufacturer if we make such a determination. CDRH may require the manufacturer to cease introduction into U.S.
commerce until deficiencies are corrected, and to initiate a corrective action program (21 CFR 1003 - 1004) for products
already introduced into commerce.
Please mail your reports to the address below (FDA can not process electronic submissions at this time). Provide the
original report with appropriate signature(s) (no facsimiles, please). Provide extra copies only if this guide specifically
requires them. Submit the report written in the English language. Translate any text that appears in a language other than
English into English in a complete and accurate manner. Keep a copy of the completed reports in your records.
We are making our reporting guides and other regulatory information available on the Internet under
http://www.fda.gov/Radiation-EmittingProducts/. No copyright exists for these guides. Reproduce these guides as needed.
If you would like to comment on the reporting guides, web site, or future electronic submissions, you may direct the comments
to the address below. If you need additional regulations for electronic products or medical devices, you should contact the
Division of Small Manufacturers, International and Consumer Assistance by telephone at 1-800-638-2041 or by facsimile at
301-847-8149.
Sincerely yours,

Lillian J. Gill
Director
Office of Compliance
E-MAIL ADDRESS: [email protected]
MAILING ADDRESS (see 21 CFR 1002.7 for further information):
CENTER FOR DEVICES AND RADIOLOGICAL HEALTH
DOCUMENT MAIL CENTER – WO66-G609
ATTN: ELECTRONIC PRODUCT REPORTS
10903 NEW HAMPSHIRE AVENUE
SILVER SPRING, MD 20993-0002
¹

Manufacturer (see 21) CFR § 1000.3(n)) means any person engaged in the business of manufacturing, assembling, or importing electronic products.

²

Accidental Radiation Occurrences: 21 CFR 1002.20 requires manufacturers to immediately report accidental radiation occurrences (see 21 CFR
1000.3(a) for the definition).

³

Notification: Title 21 CFR Part 1003 requires manufacturers to provide Notification of Defects or Failure to Comply. Send these notifications to the
above address.

FORM FDA 3640 (8/16)

CONTENTS
Page
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

Part 1: Identification of Manufacturer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

Part 2: Identification of Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

Part 3:

Show Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .

5

Part 4:

Variance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

Part 5:

5

Part 6:

Projection Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Show Venue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part 7:

Show Locations, Dates, and Times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Part 8:

Light Show Effects Produced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Part 9:

Diagrams and Drawings of Show Venue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

Part 10: Laser Radiation Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

Part 11: Scanning Safeguards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

Part 12: Operator Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

Part 13: Projection Equipment Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

..........................................................

12

Part 15: Notification Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

Footnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14

Appendix: Sample Checklist and Documentation for Laser Light Shows . . . . . . . . . . . . . . . . . . . . .

15

Part 14: Test Procedures

FORM FDA 3640 (8/16)

6

INTRODUCTION

This guide is to be used for reporting laser light shows or displays incorporating Class IIIb or Class IV
lasers only. Separate reports are not required for shows or displays that incorporate Class I, IIa, II, or IIIa
laser projection systems. Such show descriptions must be included in the user instructions and the report
for the laser projector.
Laser projectors used in any light shows or displays regardless of the class of the projector must be
certified by the manufacturer and reported using the guide titled, "Guide for Preparing Laser Product
Reports for Lasers and Products Containing Lasers," HHS publication FDA 86-8259. These guides assist
manufacturers in providing the information that the Center for Devices and Radiological Health (CDRH)
needs to determine how laser light show projectors and laser light shows comply with the Federal
standard for laser products (21 CFR 1040.10 and 1040.11) and with the conditions of and an approved
variance.
An approved variance from section 1040.11(c) is required for demonstration laser products (including
projection systems and shows) that would be Class IIIb or Class IV. Applicable reports and application
forms must be submitted and the variance approved by CDRH prior to the sale, lease, or use of a Class
IIIb or IV projector or laser light show.
A report is to be submitted for each unique laser projector, light show, or display. If you later plan to add
effects to a previously reported show or introduce a material change in the show, auxiliary projection
equipment, or projector, you must submit a supplementary report describing the additions or changes. If
you plan to introduce a projector or show that is substantially different, you must submit and an additional
laser product or light show report.
If you are the manufacturer of the projector and a Class IIIb or IV light show, then the general laser
product reporting guide must be used to provide a complete report on the whole projection system and this
laser light show guide to describe all the effects. In the Laser Product Report you would identify the
projector, including auxiliary components in the projection system, and describe any aspects of the design
of those components that satisfy a requirement of the variance or the standard.
If the projector or projection system was purchased and is certified by its manufacturer, you may provide
information concerning the projector by reference to the manufacturer's report on the projector, specifying
the model number, model name, and the CDRH accession number of that report.
However, if you have modified the projector (changed the protective housing, interlocks, apertures,
installed lasers of a different class, added remote controls, etc.) or added auxiliary equipment such as
mirrors, mirror balls, fiber optics, remote scanners, projection screens or other surfaces as targets, etc., the
modified projection system must be reported by you, using the general laser product reporting guide. As
above, the projector manufacturer's report may be referenced for any items of information that were not
affected by your modifications.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 1

A Laser Product Report or Supplemental Report must be submitted prior to introduction of changes. In
addition, you should check your variance approval letter, specifically paragraph D and the conditions in
any attachments, before you produce new shows to be certain that your variance allows the proposed
changes. If it does not, then you must apply for and receive an approved amendment to your variance
prior to introducing your new show or projector into commerce.
Your variance will be approved for a specific period of time. If you wish to produce shows after the
expiration date, several months prior to its expiration date you must request an extension in writing.
Variance extensions and renewals are subject to the adequacy and timeliness of all required reports, show
notifications, and recordkeeping. Noncompliances in your shows, projection equipment, or quality control
records would be grounds for denial of your request, or further regulatory actions.
Please submit your report(s) to: Center for Devices and Radiological Health, Document Mail Center WO66-G609, Attention, Electronic Product Reports, 10903 New Hampshire Avenue, Silver Spring,
Maryland 20993-0002. Attachments required by the guides should be numbered to correspond with the
appropriate questions (i.e., information requested by item 7.0 should be numbered 7.0).
The Product Reporting Guides and Annual Reporting Guides are available from the Division of Small
Manufacturer's Assistance (DSMA) in Rockville, Maryland at 1-800-638-2041. DSMA should be
contacted for requests of any current documents and reporting guides.
More industry guidance and assistance can be found at the FDA homepage, see: http//www.fda.gov/RadiationEmittingProducts/.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 2

REPORT ON LASER LIGHT SHOW OR DISPLAY
PART 1
IDENTIFICATION OF MANUFACTURER
1.1

Manufacturer of the laser light show:
Manufacturer
Address

Firm's prime contact or responsible person:
Name & title
Telephone number

Email

NOTE: The firm applying for the laser light show variance and intending to take responsibility for the laser
light show would be considered the manufacturer of the show.
1.2

Importing agent (if applicable)
Name & title
Address

Telephone number

1.3

Email

Name of person preparing report:
Signature
Name & title
Telephone number and Email address if different from manufacturer's phone number given above:
Telephone number

Email

NOTE: Information on laser projectors and auxiliary projection equipment is to be submitted using the
"Guide for Preparing Product Reports on Lasers and Products Containing Lasers" (Form FDA 3632).
Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 3

PART 2
IDENTIFICATION OF REPORT
2.1

2.2

2.3

Is this report pursuant to 21 CFR 1002?
(

)

Yes

(

)

a new laser light show report

(

)

a supplemental report

(

)

No

This report is:

If this is a supplemental report, give CDRH accession number and date of the laser light
show report that it supplements.
Accession number:
Date:

2.4

Date of this report:

PART 3
SHOW NAME

3.1

What is (are) the name(s) of the light show or display?

NOTE: See Part 7 to provide locations, dates, and times of shows.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 4

PART 4
VARIANCE
4.1

Attach a copy of your variance application (FDA Form 3147) or, if approved, your variance approval
letter (or variance number).

Is variance application attached?

(

)

Yes

(

)

No

Is a copy of your variance approval letter attached?

(

)

Yes

(

)

No

)

(Or enter current variance number:

PART 5
PROJECTION EQUIPMENT
5.1

List each projector used in the light show by manufacturer, model number or other designation, and
CDRH accession number for the projector, if known.
Manufacturer

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Model or designation

CDRH accession number

Page 5

PART 6
SHOW VENUE
6.1

The laser light show or display takes place in:
(

)

Planetarium or other dome projection structure

(

)

Theater

(

)

Hotel/motel ballroom or meeting room

(

)

Store displays

(

)

Trade show or convention

(

)

Discotheque or nightclub

(

)

Pavilion

(

)

Indoor arena

(

)

Outdoor arena

(

)

Museum

(

)

Outdoor unenclosed arena

(

)

Other (specify)

NOTE: Be sure to provide beam path diagrams/floor plans for each of the types of venues checked off,
unless certain drawings are general enough to cover more than one type. Drawings shall be attached
following Part 9.
6.2

The laser light show or display takes place at:
(

)

only one (fixed) location

(

)

a variety of (tour) locations

(

)

Other (specify)

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 6

PART 7
SHOW LOCATIONS, DATES, AND TIMES
7.1

Give specific locations(s), date(s), and time(s) for the show, if known.1

PART 8
LIGHT SHOW EFFECTS PRODUCED
8.1

The laser light show uses the following laser effects:
(

)

front screen projections

(

)

rear screen projections

(

)

holographic displays

(

)

multiple reflection/diffraction effects

(

)

audience scanning, including scanning any accessible,
uncontrolled areas

(

)

reflections from stationary mirrors or mirrored surfaces

(

)

stationary irradiation of rotating mirror balls, etc.

(

)

scanning irradiation of rotating mirror balls, etc.

(

)

fiber optic projections

(

)

fog, smoke, or other scattering effects

(

)

other (specify)

NOTE: Be sure that the beam path diagrams included in your response to Part 9 are sufficient to
illustrate all of the effects indicated above. Several effects may be included in a single diagram.
1

See footnote 1 at the end of this Guide.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 7

PART 9
DIAGRAMS AND DRAWINGS OF SHOW VENUE
9.1

Provide both plan and elevation drawings with dimensions of the show or display. If the setup varies
from show to show, then provide this information for a typical show. Be sure to include in the
drawings:
1. the location of the projector(s) and control panel(s), audience, performer(s), operator(s), mirrors,
mirror balls, display screens (or other targets), and beam termination points;
2. the direct and reflected laser radiation beam path;
3. the laser radiation levels in each beam including the wavelength, maximum power, and scan
parameters (if scanned) for the worst case from a human access point of view;
4. the minimum separations of the laser radiation fields (or beams) from reference locations in audience
and performer areas in both vertical and horizontal directions; and
5. any direct or reflected beams into audience or performer locations.

(

Drawings attached?

)

Yes

(

)

No

(If "No," explain)

PART 10
LASER RADIATION LEVELS
10.1

Describe how each of the laser radiation levels, indicated on the drawings above, was determined. If
any levels were derived from calculations rather than directly measured, provide the actual calculations
that were made.
Description and calculations enclosed?

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

(

)

Yes

(

)

No

Page 8

PART 11
SCANNING SAFEGUARDS
11.1

Will there be audience scanning2 from any of the planned effects?
(

11.2

)

Yes

(

)

No

)

No

Do any of the planned effects require laser radiation (direct or scanned beams) to be viewed by
operators, performers, or employees?
(

)

Yes

(

If the answer to either of the above questions is yes, describe how the radiation levels that reach into
audience areas are maintained at Class I levels by scanning. Your description must include details of the
required scan failure safeguard, including a discussion of the means of detection of the scanning, the
theory of the operation of the scanning safeguard, and its speed of response in order to show that it will
prevent the scanned radiation from exceeding the Class I limits.
(

Description attached?

11.3

)

Yes

(

)

No

(

)

No

Will any laser radiation greater than Class I STRIKE BUT NOT BE VIEWED by operators,
performers, or other employees?
(

)

Yes

If "Yes," describe, in detail, the operation of the scan failure safeguard or other means which will
prevent exposure to beams exceeding Class II. If a scan safeguard is used, include a discussion of the
detection of scanning, the operation, and the speed of response of the safeguard to show that it will
prevent the scanned radiation from exceeding the limits of Class II. If other means are used, such as
pressure pads or infrared beams, describe in detail as well.
Description attached?

2

(

)

Yes

(

)

No (If "No," explain)

See footnote 2 at the end of this Guide.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 9

PART 12
OPERATOR CONTROLS
12.1

Is the show under the continuous control of an operator?
(

12.2

)

Yes

(

)

No

(

)

No

Does the laser operator perform tasks in addition to operation of the laser projector?
(

)

Yes

If "Yes," describe those tasks:

12.3

Can the operator see all of the propagating beam paths, their terminations, and the audience at all times
during the performance?
(

)

Yes

(

)

No

Do any other personnel assist in providing surveillance of the laser display? (

)

Yes

(

)

No

If "No," explain how adequate surveillance is provided:

12.4

If "Yes," state number of persons, their identification, their duties, and how they assist in providing
surveillance. Describe how they are in constant communication with the operator.

Information attached?
12.5

What qualifications are required of laser operators for your show?3

3

See footnote 3 at the end of this Guide.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

(

)

Yes

(

)

No

Page 10

OPERATOR CONTROLS (Continued)

12.6

If your show is not under the continuous control of an operator, is a person designated to be responsible
for the immediate termination of the laser radiation in the event of equipment malfunction, audience
unruliness, or other unsafe conditions?
(

)

Yes

(

)

(

No

) Not applicable

If "No," explain alternate control:

12.7

How is this person designated? What are his or her duties?

12.8

What qualifications are required of this person?

PART 13
PROJECTION EQUIPMENT CONTROLS
13.1

Is one readily accessible control or more provided to immediately terminate laser radiation?
(

)

Yes

(

)

No

Number of controls:

13.2

Describe the location of these controls and their operation relative to your show.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 11

PART 14
TEST PROCEDURES

14.1

Attach a copy of the written setup, alignment, and test procedures to be followed prior to the operation
of the laser light show at each location (see sample checklist for laser light shows in the Appendix).
(

Procedures attached?

)

Yes

(

14.2

When are these setup, alignment, and test procedures performed?

14.3

What laser radiation levels are used during setup, alignment, and checkout?

)

No (If "No," explain)

milliwatts
14.4

Is a written record of the results of the setup, alignment, and test procedures maintained?
(

)

Yes

(

)

No

If "No," explain how adequate quality assurance is maintained:

NOTE: Adequate recordkeeping would include, but not be limited to: (1) sketches showing the location
of the laser projector(s), operator(s), performer(s), audience, beam paths, viewing screens, wall mirrors,
mirror balls, and other surfaces that may be struck by the laser beams; (2) information on scanning
patterns, velocity, and frequency; and/or (3) laser radiation levels used in each effect.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 12

PART 15
NOTIFICATION PROCEDURES

15.1

What procedures are followed for notification of appropriate Federal (CDRH, FAA), State, and local
agencies?

Procedures and/or form letters attached?

15.2

(

)

Yes

(

)

No (If "No," explain why)

What Federal, State, or local agencies are notified or would be notified?

List of agencies attached:

(

)

Yes

(

)

No

If "No," explain:

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 13

FOOTNOTES

1. Show notification:
Provide the location(s), date(s), and time(s) for this show if this information is known at the time this report is
submitted. If not, advanced written notification must be made as early as possible to appropriate Federal, State,
and local authorities. To be considered timely, this written notice must be submitted 30 days prior to the
opening of the show.
For CDRH the written show notification requirement has been replaced with a condition requiring maintenance
of certain records containing the same information. The firm or person to whom the variance is issued shall
maintain complete records of all show events or itineraries with dates, locations, operator name, and the
contact information clearly and completely identified. The records shall contain the specific equipment used, a
basic description of proposed effects, and a statement of the maximum power output used. These records shall
be available to the Food and Drug Administration upon request.

2. Audience scanning:
Audience scanning is considered to be any scanning, projection, or reflection of laser or collateral radiation
into audience or other accessible, uncontrolled areas. Scattered radiation coming from diffuse reflectors such as
fog, smoke, mist or similar diffusing media is not considered audience scanning. However, all radiation must
be below Class I levels if it reaches into audience or other uncontrolled areas. A scanning safeguard is required
whenever a laser light show includes audience scanning to ensure that the laser radiation levels in audience
areas will not exceed Class I limits if there is a scan failure. See the companion publication, "Compliance
Guide for Laser Products," for further discussion.

3. Qualifications:
Holders of variances are required by the variance to employ trained operators or to ensure that the operators
receive adequate training to qualify them for the safe use of the laser projection system and presentation of the
light show effects. Useful information, including training films, reference books, and programs on the safe use
of lasers, may be obtained from the Laser Institute of America (LIA), 13501 Ingenuity Drive, Suite 128,
Orlando, FL 32826, (800) 345-2737 (request ANSI standard Z136.1).

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 14

APPENDIX
SAMPLE CHECKLIST AND DOCUMENTATION FOR LASER LIGHT SHOWS

(Your actual modified checklist should be submitted under 14.1.)
NOTE: In order to keep your variance for a laser light show that uses Class IIIb or IV levels of laser radiation
in effect, it is essential that you maintain your show in strict compliance with the conditions of the variance.
You are therefore expected to perform checks as often as appropriate to make sure that you have not departed
from any of the conditions of the variance, and to maintain records in order to be ready for inspection by
regulatory authorities without warning.

This sample checklist shows the types of checks that should be performed during preparation for a laser light
show. It is not intended that you adopt this sample without any modification. Individual aspects of your show
may make it important to add some new items and delete others. Attach a copy of your checklist to this report
and maintain in your records those checklists that you complete for each performance.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 15

SAMPLE CHECKLIST AND DOCUMENTATION FOR LASER LIGHT SHOWS (Continued)

All items must be brought to a satisfactory state before being checked off.
A.

IDENTIFICATION
1.

Name of show

2.

Location of show

3.

Date(s) and time(s) of show

4.

Operator responsible for safety of show

5.

Manufacturer of the laser light show projector/display device:

6.

B.

a.

Name:

b.

Address:

c.

Area code and telephone: (

a.

Email:

)

Name and title of responsible person:

EQUIPMENT CHECKS (You may want to list these items in a table format for daily preshow
check-off.)
1.

Are all protective housings in place with proper tight fit?

2.

Is the projector secured rigidly in place?

3.

Before activating the laser, check that all beam shutters are operable and are left in the closed
positions.

4.

Make sure that the laser cannot be energized without the key and that key removal terminates
operation.

5.

Check that all accessories, such as mirrors and targets, are secured firmly in place.

6.

Energize the laser at the lowest possible power (without allowing the beam to emerge and with
shutters closed).

7.

Confirm that all emission indicators and the emission delay operate properly.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 16

SAMPLE CHECKLIST AND DOCUMENTATION FOR LASER LIGHT SHOWS (Continued)

8.

C.

Verify that all required labels are in place and visible on the projector:
(

)

Certification - projector's label with variance number.

(

)

Certification - light show's label with variance number.

(

)

Identification of light show manufacturer

(

)

Aperture(s)

(

)

Noninterlocked (or defeatably interlocked) protective housing(s)

(

)

Warning logotype

ALIGNMENT CHECKS
1.

Evacuate all but essential personnel from the facility. These checks must be performed with no
audience present.

2.

Make certain that you have visual control of the entire projection space from your operating
location (especially the audience space) and that areas are adequately secured (see the current
ANSI Z136.1 standard for guidance).

3.

Operate the laser at the lowest possible power, open the shutters, and perform alignments.

4.

Perform a physical survey to confirm that beams exceeding Class I will be separated from the
audience by at least the minimum distances required. (In general, for shows under operator
control, a 3 meter vertical separation and a 2.5 meter horizontal separation from audience
locations are required. For shows not under continuous operator control, a 6 meter vertical and
2.5 meter horizontal separation would be required.)

5.

Review your proposed projections with venue management to be certain that the audience will
not be permitted access to locations resulting in a violation of item 4 above.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 17

SAMPLE CHECKLIST AND DOCUMENTATION FOR LASER LIGHT SHOWS (Continued)

6.

Operate the projector at the power required for the show, making sure that there are no spurious
projections into unintended areas and that the conditions of item 4 are maintained. Determine
and record the power levels in accordance with the levels reported in Part 9 of your laser light
show report.

7.

Confirm that all projectors and optics are rigidly secured and cannot be disturbed during
subsequent setup operations or during the show itself.

8.

Check for operation and proper setting of all devices related to safety, including:

9.

D.

(

)

beam blocks

(

)

scanning safeguards

(

)

emergency stop controls

Maintain continuous surveillance of the projectors and all optics between the time of alignment
and start of the show to be certain that the alignment of the projector and optics is not disturbed.

MEASUREMENT/PARAMETRIC CHECKS
1.

List the effects to be performed.
(a)
(b)
(c)
(d)
(e)
(f)
(g)

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 18

SAMPLE CHECKLIST AND DOCUMENTATION FOR LASER LIGHT SHOWS (Continued)
2.

For each effect, give, if applicable, time duration, intended and measured power in the beams,
scan frequency and amplitude, and identification of the measuring instrument used.
(a)
(b)
(c)
(d)
(e)
(f)
(g)

E.

ADMINISTRATIVE CHECKS
1.

List the name and title of the person responsible for safety at the show facility.

2.

List those agencies you have notified of your show.

Attach a copy of your notifications.
3.

Attach plan and evaluation drawings showing the locations of all projectors, external optics,
projections, and audience.

NOTE: Safety considerations mandate that you account for all specular reflections and that
the operator have visual control of all projections at all times.

Laser Light Show Report (9/95)
FORM FDA 3640 (8/16)

Page 19