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Radiation Safety Forms

The following forms are in PDF format and can be viewed using the Adobe Acrobat Plug-in. If you need the Plug-in, click the icon below.
 

RSC Approved Forms

PDF Version

RS FORM 2.0 Radiation Worker/Dosimetry Application (6/06) PDF Version
RS FORM 2.1 (RAM) Documentation of AU Lab Specific Radiation
Worker Training/Interview (8/04)
PDF Version
RS FORM 2.1 (XRAY) Radiation Safety Training for Non-Human Use RGE PDF Version
RS FORM 2.2

Documentation of AMP Medical Physicist Specific Radiation Worker Training/Interview

PDF Version
RS FORM 3 Radioactive Waste Container Log Sheet (8/04) PDF Version
RS FORM 4 Non-Compliance Response Form (8/04) PDF Version
RS FORM 6 Application for Non-Human Use of
Radioactive Material (6/06)
PDF Version
RS FORM 6.1 Statement of Prior Training and Experience (8/04) PDF Version
RS FORM 7 Radiation Incident Report (8/04) PDF Version
RS FORM 10A RAM Transfer Request (8/04) PDF Version
RS FORM 10B I-125 RAM Transfer Request (8/04) PDF Version
RS FORM 12 Authorized User Routine Laboratory Survey Report (8/04) PDF Version
RS FORM 14 Radioactive Material Request (6/06) PDF Version
RS FORM 19 Emergency Notification (6/06) PDF Version
RS FORM 24 Decommissioning of RAM-Use Room (8/04) PDF Version
RS FORM 30 Application for Clinical Human Use of
Radioactive Material (6/06)
PDF Version
RS FORM 31 Application for Investigational Human Use of Radioactive Material (6/06) PDF Version
RS FORM 32 Radioiodine Users Sheet - Unsealed Sources Only (8/04) PDF Version
RS FORM 33 Declaration of Pregnancy (8/04) PDF Version
RS FORM 34 Emergency Procedures Incidents Involving
Radioactive Material (6/06)
PDF Version
RS FORM 35 Application for Authorized Medical Physicist (6/06) PDF Version
RS FORM 36 Trustworthy and Reliable Form PDF Version
RS FORM 36A Expanded Background Screen Information PDF Version
RS FORM 37 Responsible Administrator of Fixed RAM Contaminated Space PDF Version
RS FORM 38 Release of Liability and Waiver Claim PDF Version
RS FORM 38A Supervisor's Statement PDF Version
RGE DISPOSITION Notice Of Transfer or Disposal of Radiation Generating Equipment (X-Ray) PDF Version

MISCELLANEOUS FORMS

(NOT APPROVED THROUGH RSC)

RS FORM 2.1 (HUMAN USE X-RAY) Radiation Safety Training for Human Use RGE (Draft) PDF Version
SPILL/CONTAMIN. REPORT Spill Contamination Report PDF Version