Radiation Safety: Forms and Application Process

Forms and Applications
Application for Clinical Authorized User Status	Required form to become a Clinical Authorized User of Radioactive Materials or an Authorized Medical Physicist of Radioactive Materials.

Application for Authorized User Status for External Beam Radiation Therapy	Required application to become an Authorized User of External Beam Radiation Therapy (EBRT).

Application for Use of Radioactive Material (Research Use)	Required application to become a Research Authorized User of Radioactive Material.

Radioisotope Use Amendment Request	Required form for the amendment of your current Research Authorized User status.

Additional Project Forms	This form is used to describe the process for each research project.

Request for Dosimeter Service	Required form to receive dosimeter service.

Declaration of Pregnancy Form Information on Occupation Exposure During Pregnancy	Declaration of Pregnancy is a voluntary process. The radiation worker submits a written notification of the pregnancy to the Radiation Safety Office. This permits fetal dose monitoring during the gestation period.

Emergency Contact Numbers	Emergency Contact Numbers to be posted in all areas where radioactive material is used or stored.

Quarterly Radioactive Material Physical Inventory	Required submission form for the inventory of all research laboratory radioactive materials and all clinically used sealed sources.

Sink Disposal of Radioactive Waste	Required log for all radioactive waste disposed into the University of Toledo sanitary sewer system.

Radioactive Waste Container Log	Required document to record the quantity and activity of all waste materials contaminated with radioactive materials.

Radioisotope Usage and Disposition Log	Required document to track all movements of radioactive materials into and out of a laboratory.

Research Lab Area Survey Form Research Lab Monthly Wipe Test Form	Required forms used in the monitoring of research labs that use radioactive materials.

Statement for Minors	Required form to be used if a minor is to be working in a research lab that uses radioactive material or radiation generating equipment.