Radiation Safety Forms

Instructions: Fill out form using Microsoft Word and email as an attachment to mccumbee@marshall.edu. Fields requiring a signature from the RSO are marked in red and should be disregarded. Any required attachments (such as floor plans) should be sent as an attachment in an email to mccumbee@marshall.edu alongside the corresponding form.

  • Form 1-A  Application for Use of Radioisotopes
  • Form 1-B Statement of Training and Experience
  • Form 1-C Radiation Equipment
  • Form 1-D Application For Use Of Radiation Producing Devices
  • Form 2 Request for Use of Radioisotopes in Animals or Plants
  • Form 3 Radioactive Material Shipment Receipt Report
  • Form 4-A Records of Dose-Rate Survey and Report
  • Form 4-B Records of Contamination Survey and Report
  • Form 5-A Quarterly Radioisotope Report
  • Form 5-B Quarterly Radioisotope Report
  • Form 6 Radioactive Disposal Form (Must be submitted with Quarterly Isotope Report)
  • Form 6-A Radioactive Waste Composition Record
  • Form 7 Exposure History Release Form
  • Form 8 Radiation Exposure Report
  • Form 9-A Leaktest Activity Measurement
  • Form 9 Certification of Leak Test
  • Form 10 Record of Thyroid Scan/Bioassay
  • Form 11 Transfer of Radioactive Materials