Forms for Working with Radioactive Materials

Radiation Permit Application

A Radiation Permit Application must be completed and submitted to DRS for approval before the procurement, possession, or use of radioactive material is permitted on campus.

Dosimetry Request Form

To obtain dosimetry, complete a Dosimetry Request Form and return it to DRS. DRS assigns dosimetry when certain quantities and nuclides are used. Specifically, the use of >10 mCi of P-32 requires the user to wear both an extremity (commonly referred to as a “ring”) and a whole-body dosimeter. At usage levels ≤10 mCi of P-32, dose assessments will be performed to evaluate the need for dosimetry. DRS evaluates the use of dosimetry with other radionuclides and quantities on a case-by-case basis.  Note that dosimetry is not issued for individuals working with weak beta-emitting radionuclides such as H-3, C-14, S-35.

Survey Log

Surveys are performed to monitor for the presence of contamination. Minimum survey frequencies are specified on the radiation permit. The surveys should be sufficiently extensive to allow confidence that there is no contamination. Survey results must be documented on a survey log. DRS will review survey logs during lab audits; using this log should ensure no findings of non-compliance during the DRS audit process.

Radioisotope Use and Waste Log

The Radioisotope Use and Waste Log must/should be used for the accountability of radioactivity materials. DRS will review radioisotope use and waste logs during lab audits; using this log should ensure no findings of non-compliance during the DRS audit process.

Recommended Reading for Pregnant Female Radiation Workers

Any radiation worker who is pregnant or believes that she may be pregnant should contact DRS and review the Recommended Reading for Pregnant Female Radiation Workers. All inquiries will be confidential. The individual must complete a Declaration of Pregnancy Form. If a written declaration of pregnancy is not submitted, then the worker’s dose continues to be controlled under the normal dose limits for radiation workers.

Declaration of Pregnancy Form

Any radiation worker who is pregnant or believes that she may be pregnant should contact DRS and completed a Declaration of Pregnancy Form. All inquiries will be confidential.  If a written declaration of pregnancy is not submitted, then the worker’s dose continues to be controlled under the normal dose limits for radiation workers.

Certification of Radiation Safety Instruction Form

The Certification of Radiation Safety Instruction Form is a signature sheet that certifies that the individuals listed have been instructed in the safe use of ionizing radiation sources. 

Radiation Safety Awareness Training Signature Sheet

The Radiation Safety Awareness Training Signature Sheet is training documentation used to certify that the individuals listed have received and understand the Radioactive Materials Safety training.

Last Update: 6/13/2014