Radiation Safety Committee Forms

The Radiation Protection office maintains the following forms:

For the written acceptance of responsibilities while using radioactive materials. Required of all personnel on a Radioactive Material Permit.

Download Form

For radiation workers to declare a pregnancy and receive fetal dosimetry (RSO interview required).

Pregnancy Declaration Page

For requesting radiation monitoring dosimetry.

Request for Dosimetry

For completion by all users authorized to use the irradiator unattended.

Download Form

For the written acceptance of responsibilities as laboratory supervisor of a radioactive materials laboratory. Required of the laboratory supervisor on a Radioactive Material Permit.

Download Form

For the disposal of all Class IIIB or IV lasers.

Download Form

For any investigator planning to work with Class IIIB or IV lasers.

Complete Online Form

For any user listed on authorized personnel on a Laser Permit, this form must be completed and signed.

Download Form

For the written acceptance of responsibilities as permit holder of a Radioactive Material Permit. Required of the permit holder of a Radioactive Material Permit.

Download Form

For completion by investigators who are planning to work with radioactive materials in humans.

Download Form

For completion by investigators who are planning to work with radioactive materials not in humans.

Download Form

For completion by investigators who need to change or renew their Radioactive Material Permit.

Download Form

For logging radioactive materials disposal.

Download Form

For any investigator planning to work with radioisotopes.

Log in to RIMS to Complete

For logging the sink discharge of radioactive materials.

Download Form