Radiation Safety Forms

Documents associated with Radiation Safety
Titlesort descending Description File Name
BSRPC - Authorization Request

Basic Science Radiation Protection Committee (BSRPC) Applications for Non-Medical Use of Radioactive Materials Form Use this form when making initial application for approval to use radioactive materials for non-medical purposes.

Microsoft Office document icon Non-Human form1rev 11-5-13.doc
BSRPC - Administrative Amendment

Basic Science Radiation Protection Committee (BSRPC) Applications for Non-Medical Use of Radioactive Materials Use this form to amend possession limits of previously approved radionuclides, use and storage locations, and/or add or delete personnel authorized to work with radioactive material.

Microsoft Office document icon Non-Human form3 rev090717.doc
BSRPC - Application Cancellation Form

Basic Science Radiation Protection Committee (BSRPC) Applications for Non-Medical Use of Radioactive Materials Use this form to cancel your application for Non-Human Use of Radioactive Materials

Microsoft Office document icon BSRP - Application Cancellation Form.doc
BSRPC - Methodology Amendment

Basic Science Radiation Protection Committee (BSRPC) Applications for Non-Medical Use of Radioactive Materials Use this form to add radionuclides and/or new methodolgies to an existing authorization.

Microsoft Office document icon Non-Human Form2 rev090717.doc
BSRPC - Survey Receipt Utilization and Disposal Form

Use this form to document radioactive inventory and survey results.

PDF icon BSRPC – Survey Receipt Utilization and Disposal Form.pdf
HRSRG - Compound Radiopharmaceutical Form

Hospital Radiation Safety Review Group (HRSRG) Application for Routine Clinical Use of Radioactive Material. Use this application for Clinical use of Compounded Radiopharmceuticals in the UIHC.

PDF icon HRSRG Compound radio form.pdf
HRSRG – Radioactive Material Devices

Hospital Radiation Safety Review Group (HRSRG) Applications for Routine Clinical Use of Radioactive Material Forms. Use this application for clinical use of radioactive materials devices in the UIHC.

Microsoft Office document icon HRSRG - Radioactive Material Devices
Laser Registration for Class 3b and Class 4 Lasers

Form to register Class 3b and Class 4 Lasers.

Microsoft Office document icon Laser Registration for Class 3b and Class 4 Lasers.doc
MRPC - Additional External Radiation Form

Medical Radiation Protection Committee (MRPC) Applications for Medical Research Use of Radiation Complete this form when radiation sources will be used outside the body for research-related diagnostic procedures

Microsoft Office document icon MRPC Additional External Rad Form.doc
MRPC - Long Form Diagnostic

Medical Radiation Protection Committee (MRPC) Applications for Medical Research Use of Radiation Use this form for New Applications involving Diagnostic Radiation Procedures

Microsoft Office document icon MRPC Long form diagnostic
MRPC - Long Form Diagnostic Example

Medical Radiation Protection Committee (MRPC) Applications for Medical Research Use of Radiation

Microsoft Office document icon MRPC Long form Diagnostic Example
MRPC - Long Form Therapeutic

Medical Radiation Protection Committee (MRPC) Applications for Medical Research Use of Radiation Use this form for Theraputic Radiation Procedures

Microsoft Office document icon MRPCLongFormTherapeutic.doc
MRPC - Short Form

Medical Radiation Protection Committee (MRPC) Applications for Medical Research Use of Radiation

Microsoft Office document icon MRPC Short Form Diagnostic
MRPC Additional Internal Radiation Form

Complete this form when radioactive materials will used inside the body for research-related diagnostic procedures.

Microsoft Office document icon MRPC Additional Internal Rad Form.doc
MRPC Laser Form for Class 3b and 4 Lasers

Medical Radiation Protection Committee (MRPC) Application for Medical Research Use of Radiation Form. This form is to be used for projects involving research related use of Class 3b & 4 lasers.

Microsoft Office document icon MRPC - Laser Form for Class 3b and 4 Lasers.doc
PPE - Research Laboratory Hazard Assessment Tool

Personal Protective Equipment hazard assessment tool

PDF icon labppetool form final.pdf
Pregnancy Declaration and Prenatal Radiation Exposure Form

EHS has established a Pregnancy Declaration Program as required by State radiation safety regulations. This program provides information and consultation concerning prenatal radiation exposure as well as dose monitoring of the embryo/fetus at the mother & rsquo's request.

Microsoft Office document icon PregDeclarationandPrenatalRadExposForm.doc
Radioactive Materials Transferred on Campus

Form to transfer radioactive material to another approved user on-campus.

Microsoft Office document icon On Campus Rad Transfer Form.doc
RDRC Form

Radioactive Drug Research Committee Form - Use this form to apply for authorization to conduct basic research regarding the metabolism, distribution, and localization of a radioactive drug in humans (as defined by 21 CFR 361.1) in preparation for applying for an IND

Microsoft Office document icon rdrcform.doc