Truth or Dare: Is an LSO required? Fill out this form to receive your certificate for the July 24th webinar.Name* First Last *Please ensure your name is entered correctly as this is how it will appear on your certificate.Email* PhoneFacility Name*Job Title*Compared to other webinars you have attended, how did this presentation compare?* 1 - Not good at all 2 - Somewhat 3 - About average 4 - Better than most 5 - It was excellent How relevant was the material presented to your job role?* Not at all relevant Not relevant Relevant Very relevant Extremely relevant How likely are you to recommend OR Today webinars to a colleague?* Not at all Not likely Likely Extremely likely Are you interested in learning more about the products/services discussed in today’s webinar? Provide your preferred contact method and today’s presenter/sponsoring company will reach out.*What do ORT webinars provide the industry?*What types of medical lasers are currently in use at your facility?* CO₂ Nd:YAG Diode Er:YAG Excimer Approximately how many laser-based procedures are performed annually?* <100 100–500 500–1,000 >1,000 Where are lasers used in the facility? (Check all that apply) Select All Operating Rooms Outpatient Clinics Dermatology/Plastic Surgery Ophthalmology Urology/Gynecology Mobile Laser Services If other, please specify:Have there been any laser-related safety incidents, near misses, or regulatory citations in the past 12–24 months?* Yes No If yes, please specify:Are we currently compliant with ANSI Z136.3 standards?* Fully Partially Unsure Do accrediting bodies (e.g., The Joint Commission, CMS) require a designated Laser Safety Officer or documented laser safety program?* Yes No Unsure When was your last internal or external laser safety audit?* Within the past year 1–3 years ago >3 years ago Never Who is currently responsible for ensuring laser safety and operator training?* No one assigned Departmental Supervisor OR Nurse Manager Biomedical/Clinical Engineering Are all clinical laser users documented as trained and competent in laser safety?* Yes No Partially Is laser safety training and refresher education conducted regularly?* Annually Only upon hire Not consistently Never Would assigning an MLSO help improve regulatory compliance?* Yes No Would assigning an MLSO help improve incident prevention?* Yes No Would assigning an MLSO help improve staff training oversight?* Yes No Would assigning an MLSO help improve documentation and reporting?* Yes No Would assigning an MLSO help improve credentialing and vendor management?* Yes No Could an existing employee be trained to fulfill the MLSO role?* Yes No (Dedicated hire required) What are the risks of not appointing an MLSO? (Check all that apply) Select All Regulatory non-compliance Patient/staff injury Liability/legal exposure Delays in procedures due to poor laser management If other, please specify:What are the potential costs associated with a laser-related incident? Estimated direct costs: $ (please list)*What are the potential costs associated with a laser-related incident? Estimated liability exposure: $ (please list)*What are the potential costs associated with a laser-related incident? Reputational impact:* Low Moderate High Estimated cost/resources to establish and support the MLSO role? Training (e.g., LIA certification): $*Estimated cost/resources to establish and support the MLSO role? Time allocation: ____ hours/week*Estimated cost/resources to establish and support the MLSO role? Salary adjustment (if applicable): $ Δ