Clinical Competency Validation ChecklistGreenLight HPSTM Surgical Laser SystemName/Title_____________________________________________________Date____________Unit/Department ________________________________________________________________InitialsPerformance Criteria Criteria Met Commentsand Date1. Completed basic training course highlighting lasersafety and physics specific to the GreenLight HPS™laser system and procedures performed in the facility.2. Prepares surgical suite for laser use:• Covers all windows with opaque covering (placedon inside of window)• Posts laser warning signs, specific to the laserbeing used on all access doorways• Inspects laser safety eyewear for scratches ordamage• Has laser wavelength specific safety eyewearposted at all access doors to surgical suite• Fire extinguisher and basin of water areimmediately availablePerforms proper laser system setup steps:3.• Knows location of laser serial number• Inspects power cord for damage prior toconnection to wall outlet.• Demonstrates connection of foot pedal tolaser• Turns on circuit breaker at rear of laser• Powers laser on• Observes self-test• Inserts fiber card successfully• Connects GreenLight HPSTM fiber to laser correctly• Identifies fiber serial number (located at machineconnection of laser fiber)• Places GreenLight HPSTM fiber in fiber support pole• Knows location of Emergency Laser StopButton4. Laser Safety During Procedure• Ensures that all personnel in room wear wave-length specific laser safety goggles• Ensures that patient’s eyes are appropriatelyprotected. Patients who are awake are givenwave-length specific goggles. Patients whoundergo general anesthesia are provided withother appropriate protection such as wet eye padsor laser-specific eye shields.• Demonstrates proper placement of foot-pedal andblack connecting hose in a position convenient tothe surgeon; preventing unintended footswitchactivation or potential damage to the cord by thelaser, personnel, or other equipment.