Radiation Safety Manual 1997

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Statement of Training and Experience
Training and Experience  Record
Worksheet for Radiochemical Protocols
Declaration of Pregnancy
Film Badge Service Request
Lost Dosimeter Report
Authorization to Obtain Radiation Exposure History
Film Badge Report
Currently Authorized Radioactivity Users Report
CRA Room Use Report
Radionuclide Inventory
Sealed Source Inventory Summary
Dry Radioactive Waste Pickup Request
Dry Radioactive Waste Pick-up Request Additional Page
User Radiation Survey Report
User Survey Log
Radioisotope Use Log
Storage Container Summary Log
Package Safety Information
Radioactive Animal Notice
Transfer of Radioactive Material Form
Sample Hazards Evaluation

  


Part IV: User Radiation Survey Report

The Adobe Acrobat Version of this form can be filled out on-line or after printing, then sent to Health Physics by FAX or mail.
user survey report.GIF (85878 bytes) The lab drawing should show equipment, work areas, and clean areas.
Number each area where you take a removable contamination swipe.

Record exposure rates in mR/hr.
Identify the instrument used for the exposure rate surveys.
Identify the instrument used to count the removable contamination swipes. Attach the LSC printout to this record.
Check to ensure other safety measures are in place.
Log the survey on the User Survey Log and file the survey report in the Radioisotope Journal.