ENVIRONMENTAL HEALTH & SAFETY

Forms & Applications

Radiation Safety Electronic Forms

You must return your completed application (form) to our office for review and approval!

• Authorization Amendment Form
• Authorized Medical Physicist
• Authorized Nuclear Pharmacist
• Authorized User Application
• Dosimeter Application:
• Complete the Dosimeter Application with our online form (log-in)
• OR
• Complete the Dosimeter Application and email to Karen Hyde (grm4na@virginia.edu).
• General User Application
• "Notice To Employees" - State Form
• NRC Regulatory Guide 8.13 - Instructions Concerning Prenatal Radiation Exposure
• Declaration of Pregnancy Form
• Withdrawal of Pregnancy Declaration Form
• NRC Regulatory Guide 8.29
• Principal Investigator Application
• Qualified User Application
• Radioactive Material Waste Ticket
• Affix this form to the top of the container.
• Once you have completed filling out the form, save it on your computer using the following naming style: "PI Last Name, YYYY-MM-DD". Then click on the following hyperlink to mail this document: EHS-RadWaste@virginia.edu
• Radioisotope Survey Sheet
• Radioisotope Inventory Log Sheet
• Use of Radioactive Material at a New Location

Authorizations

• Principal Investigator: The PI application will be reviewed by a Health Physicist, the Radiation Safety Officer, and two members of the RSC. If approved during this initial review, the application will be submitted to the RSC for vote of approval. Upon approval, the new user will receive a letter of authorization that is sent to him or her from the Radiation Safety Officer on behalf of the Radiation Safety Committee.
• General User (GU) & Qualified User (QU) Applications: Applications for GU and QU status must be signed by the responsible PI. The application is reviewed by several members of the Radiation Safety Staff to ensure completeness and to determine that the laboratory will be adequately equipped to handle the materials described in the application. It is also reviewed to determine if the individual has completed the required training. If the application is determined to be complete, it is then reviewed by and approved by a staff Health Physicist and the RSO. The GU and QU applicants will be formally approved by the RSC at the next meeting.