COVID-19: Keeping Campus Safe.

Radiation Safety Forms

Instructions: Fill out form using Microsoft Word and email as an attachment to 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 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