Radiation Forms

Note: Please consult the Radiation Safety Manual or contact Greg Bell, bellgl@appstate.edu or (828) 262-7113 if you have any questions on the use of the Radiation Safety forms.

 
General Radiation Safety Forms
FORMPURPOSEVERSION DATE
University Radiation Laboratory Safety Rules (pdf)

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

02/07/2018
Radiation Accident/Incident Report (docx)

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

02/07/2018
Forms for Consumable Sources
FORMPURPOSEVERSION DATE
Application for Radiation Use Authorization (RUA) (docx)

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.

02/13/2018
Application for New Radioactive Materials (ANRM) (docx)

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.

02/13/2018
RUA Annual Reporting Form (docx)

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.

02/16/2018
Application for Disposal of Radioactive Material (ADRM) (docx)

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

02/16/2018
Forms for Sealed Sources
FORMPURPOSEVERSION DATE
Sealed Source Management Plan (SSMP) Form (docx)

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

02/16/2018
Sealed Source Wipe Test Report (WTR) (docx)

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

02/16/2018
Application for Disposal of Radioactive Material (ADRM) (docx)

This form should be used to request radioactive waste disposal.

02/16/2018
Forms for X-Ray Producing Machines
FORMPURPOSEVERSION DATE
Application for Radiation Use Authorization for X-ray Producing Machines (RUAXPM) (docx)

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

02/16/2018
 

Business Affairs Websites

Contact

Office of Environmental Health, Safety and Emergency Management
P.O. Box 32112
Boone, NC, 28608 USA
(828) 262-4008

Business Services Building
1039 State Farm Road
Boone, NC

Questions or Comments?
Please contact us. 


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