Radiation Forms

Note: Please consult the Radiation Safety Manual or contact Robin Tyndall (262-2692) or Dr. Brian Raichle (262-2949) if you have any questions on the use of the Radiation Safety forms.

General Radiation Safety Forms

Form Purpose Version Date
University Radiation Laboratory Safety Rules (pdf 17.93 KB)

The Appalachian State University Radiation Laboratory Safety Rules should be posted in every radiation use area and should be observed at all times.

04/26/2013
Radiation Accident/Incident Report (docx 64.31 KB)

In the event of an accident or unanticipated incident involving radiation, RUA holders must submit this form to the RSO.

04/26/2013

Forms for Consumable Sources

Form Purpose Version Date
Application for Radiation Use Authorization (RUA) (docx 28.65 KB)

Any faculty/academic staff member who wishes to order, purchase, possess or use consumable radioactive materials must obtain a RUA. Any research assistant who plans to use consumable sources for a period of time longer than one month under the direction of an ASU faculty or staff member must obtain an RUA.

04/26/2013
Application for New Radioactive Materials (ANRM) (docx 26.78 KB)

Only an ASU faculty or staff member with an approved RUA may acquire new radioactive material.  An ANRM must be completed and approved prior to ordering or receiving any materials.

04/26/2013
RUA Annual Reporting Form (docx 28.43 KB)

This form should be completed annually by faculty/staff with an RUA.  In addition to the annual report form, RUA holders must complete annual training.

04/26/2013
Application for Disposal of Radioactive Material (ADRM) (docx 65.75 KB)

This form should be used to arrange for radioactive waste disposal.

04/26/2013

Forms for Sealed Sources

Form Purpose Version Date
Selaed Source Management Plan (SSMP) Form (docx 68.94 KB)

This form should be completed by the primary point of contact for the sealed sources.

04/26/2013
Sealed Source Wipe Test Report (WTR) (doc 90.5 KB)

Sealed sources require a biannual wipe test to be conducted by the RSO.

04/26/2013
Application for Disposal of Radioactive Material (ADRM) (docx 65.75 KB)

This form should be used to request radioactive waste disposal.

04/26/2013

Forms for X-Ray Producing Machines

Form Purpose Version Date
Application for Radiation Use Authorization for X-ray Producing Machines (RUAXPM) (docx 31.86 KB)

Faculty or academic staff members who wish to procure new x-ray producing machines must complete this form to obtain approval.

04/26/2013

Contact

Director of Research Protections
Robin Tyndall
828-262-2692
tyndallrs@appstate.edu

Assistant Director of Research Protections
Monica Molina
828-262-4060
molinamm@appstate.edu

Assistant Director of IACUC and IBC Programs
Shante' Mathes
828-262-2901
mathessc@appstate.edu

Compliance Coordinator
William Ward
828-262-2721
wardwb@appstate.edu

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