Illinois Form Iema 243 – Fill Out and Use This PDF

Illinois Form IEMA 243 is a critical component in the compliance process of any business that is located within the state. This document provides additional information to be filled out, ensuring that companies have dealt with all the steps necessary for completing their compliance program. Furthermore, IEMA 243 not only prepares businesses for possible objections from inspectors or audits, it also guarantees that all safety set forth by law are met. As a result of submitting this form, gaining state compliance and authorization for your business operations is quick and effortless. Consequently, it is imperative for all businesses who plan on operating in Illinois to acquire IEMA 243 for complete and justified protection.

Illinois Form Iema 243 PDF Details

Are you looking for more information about the official Illinois Emergency Management Agency (IEMA) 243 form? Completing and submitting these forms can ensure that people have access to resources during times of emergency, but it’s important to understand what is required and how the form works. In this blog post, we’ll provide an overview of IEMA 243 in Illinois, including details on who should complete the form, what information is included in it and when forms must be submitted. This detailed look at IEMA 243 will help guide anyone living in or visiting Illinois through completing these vital documents accurately — so let’s dive into all things IEMA 243!

Question	Answer
Form Name	Illinois Form Iema 243
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	laser expanded form of laser

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STATE OF ILLINOIS

Illinois Emergency Management Agency - Division of Nuclear Safety

LASER REGISTRATION

ILLINOIS EMERGENCY MANAGEMENT AGENCY -

DIVISION OF NUCLEAR SAFETY

1035 OUTER PARK DR

SPRINGFIELD, IL 62704

217-785-9921

ORIGINAL REGISTRATION		LASER
		REGISTRATION NUMBER
AMEND REGISTRATION		REGISTRATION NUMBER
AMEND REGISTRATION

	change of operator/address

	change of equipment	IEMA will assign if new

Registration is required for Class 3b and Class 4 laser systems. All other laser systems are

exempt. If the classification is unknown, refer to the label on the device. If you have any

questions regarding laser classification or registration, please contact the Agency.

Is this a registered x-ray

installation?

	YES		NO

The following information is provided in accordance with 32 Ill. Adm. Code 315 regarding laser registration.

ADMINISTRATOR / OWNER (NAME AND TITLE):

LASER SAFETY OFFICER:

FACILITY NAME:

STREET ADDRESS:

CITY:

STATE:

ZIP:

COUNTY:

FEIN/TAX FILING #:

TELEPHONE:

E-MAIL:

FAX:

LASER REF. NUMBER:

Check here if new:

MANUFACTURER NAME:

MODEL NAME/NUMBER:

CONTROL SERIAL NUMBER:

ACQUISITION DATE:

LOCATION:

STATUS OF UNIT:

Operable

Inoperable

Stored

Sold to supplier

Junked

Traded

Sold / Private:

LASER CLASSIFICATION:

LASER USE:

Research

Medical

Industrial

Demonstration

Entertainment

This form properly compleed and filed with the Illinois Emergency Management Agency (IEMA), constitutes registration of the laser installations herein named in accordance with Section 20 of the Laser System Act of 1997 420 ILCS 56/20. IEMA is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined in 420 ILCS 56/10. Disclosure of this information is required. Failure to comply with the provisions of the Act is a Class B misdemeanor.

LASER REF. NUMBER:

Check here if new:

MANUFACTURER NAME:

MODEL NAME/NUMBER:

CONTROL SERIAL NUMBER:

ACQUISITION DATE:

LOCATION:

STATUS OF UNIT:

Operable

Inoperable

Stored

Sold to supplier

Junked

Traded

Sold / Private:

LASER CLASSIFICATION:

LASER USE:

Research

Medical

Industrial

Demonstration

Entertainment

PRINT OR TYPE NAME

	SIGNATURE	DATE
IEMA 243 (Rev. 6/10)	IOCI1025-10	LASER REGISTRATION FORM DEP-L

LASER REGISTRATION

LASER REF. NUMBER:

Check here if new:

MANUFACTURER NAME:

MODEL NAME/NUMBER:

CONTROL SERIAL NUMBER:

ACQUISITION DATE:

LOCATION:

STATUS OF UNIT:

Operable

Inoperable

Stored

Sold to supplier

Junked

Traded

Sold / Private:

LASER CLASSIFICATION:

LASER USE:

Research

Medical

Industrial

Demonstration

Entertainment

LASER REF. NUMBER:

Check here if new:

MANUFACTURER NAME:

MODEL NAME/NUMBER:

CONTROL SERIAL NUMBER:

ACQUISITION DATE:

LOCATION:

STATUS OF UNIT:

Operable

Inoperable

Stored

Sold to supplier

Junked

Traded

Sold / Private:

LASER CLASSIFICATION:

LASER USE:

Research

Medical

Industrial

Demonstration

Entertainment

LASER REF. NUMBER:

Check here if new:

MANUFACTURER NAME:

MODEL NAME/NUMBER:

CONTROL SERIAL NUMBER:

ACQUISITION DATE:

LOCATION:

STATUS OF UNIT:

Operable

Inoperable

Stored

Sold to supplier

Junked

Traded

Sold / Private:

LASER CLASSIFICATION:

LASER USE:

Research

Medical

Industrial

Demonstration

Entertainment

LASER REF. NUMBER:

Check here if new:

MANUFACTURER NAME:

MODEL NAME/NUMBER:

CONTROL SERIAL NUMBER:

ACQUISITION DATE:

LOCATION:

STATUS OF UNIT:

Operable

Inoperable

Stored

Sold to supplier

Junked

Traded

Sold / Private:

LASER CLASSIFICATION:

LASER USE:

Research

Medical

Industrial

Demonstration

Entertainment

COMMENTS:

IEMA 243 (Rev. 6/10)

Illinois Form Iema 243 – Fill Out and Use This PDF

Illinois Form Iema 243 PDF Details

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