Radiation Forms

Please consult the Radiation Safety Manual or contact (828) 262-4008 if you have any questions on the use of the Radiation Safety forms.

FormPurposeCategoryVersion Date
University Radiation Laboratory Safety RulesThe Appalachian State University Radiation Laboratory Safety Rules should be posted in every radiation use area and should be observed at all times.General Radiation Safety02/07/2018
Radiation Accident/Incident ReportIn the event of an accident or unanticipated incident involving radiation, RUA holders must submit this form to the RSO.General Radiation Safety02/07/2018
Application for Radiation Use Authorization (RUA)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 App State faculty or staff member must obtain an RUA.Consumable Sources02/13/2018
Application for New Radioactive Materials (ANRM)Only an App State 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.Consumable Sources02/13/2018
RUA Annual Reporting FormThis form should be completed annually by faculty/staff with an RUA. In addition to the annual report form, RUA holders must complete annual training.Consumable Sources02/16/2018
Application for Disposal of Radioactive Material (ADRM)This form should be used to arrange for radioactive waste disposal.Consumable Sources & Sealed Sources02/16/2018
Sealed Source Management Plan (SSMP) FormThis form should be completed by the primary point of contact for the sealed sources.Sealed Sources02/16/2018
Sealed Source Wipe Test Report (WTR)Sealed sources require a biannual wipe test to be conducted by the RSO.Sealed Sources02/16/2018
Application for Radiation Use Authorization for X-ray Producing Machines (RUAXPM)Faculty or academic staff members who wish to procure new x-ray producing machines must complete this form to obtain approval.X-Ray Producing Machines02/16/2018