Laser systems used in operating and procedure rooms are high-energy devices that can create multiple concurrent hazards, including direct and reflected beam exposure, eye injury, surgical smoke exposure, and fires in oxygen-enriched environments. Although many institutions maintain laser policies, gaps persist between theoretical wavelength-specific risk information and the moment-to-moment decisions made by surgical teams. This narrative review synthesizes major safety standards and clinical guidance, differentiating itself from traditional guidelines by explicitly converting physical hazard data into a practical, workflow-oriented checklist. The framework emphasizes the role of foundational laser safety program elements, plume and surgical smoke control, fire prevention, protective eyewear, reflection control, and emergency response protocols. A central contribution to this framework is a “translation layer” that maps wavelength bands and delivery platforms to actionable control points across perioperative phases. To enhance clinical usability, the dispersed safety steps are consolidated into a comprehensive checklist, and specialty-specific clinical scenarios illustrating potential hazards are discussed. Key priorities include defining the nominal hazard zone, enforcing the use of optical-density eyewear, and standardizing emergency responses, such as airway fire management.