Radioactive Material Receipt Form - PDF - PDF by pp00pp


									                   DFCI RADIATION SAFETY OFFICE

Massachusetts DPH regulations require that radioactive packages be monitored for
external radiation levels and surface contamination within 3 hours of arrival. This form
must be returned to JFB 133 (fax to 632-1932) as soon as the monitoring is complete.

Date:_______________ Purchase Order Number:___________________

Name:_______________________________ Permit Holder:_________________

Building and Lab:_________________ Phone:_____________________
                       3       14       32       33       35       51        125
Isotope(s) Received:       H        C        P        P        S        Cr         I Other:_____________

Activity Received (in µCi, mCi or Bq):_______________________


Using a GM detector with a survey meter, measure and record:

1. Background Radiation Level (in mR/hr):_________________________ mR/hr

2. Radiation Level (in mR/hr) at 1 meter from package:_______________ mR/hr

3. Highest Radiation Level (in mR/hr) from package surface____________ mR/hr

4. Meter Serial #:______________ Date of Last Calibration:________________


Wipe tests must be counted with a liquid scintillation counter (or GM probe for 32P).
Wipe all sides of the package, covering at least 100 cm2 of surface. Immediately report
any wipe results over 2200 DPM / 100 cm2 to the RSO at 2-3005.

1. Wipe test background level: _______________counts per minute (CPM)

2. Wipe test of package surface: _____________________________ CPM

3. Wipe test of inside container of radioactivity: _________________ CPM

4. Counting Efficiency for Isotope(s) in question:__________________ %

Send this form to JFB 133 or fax it to 632-1932 upon completion.

                                                                                              (rev 4: 1-25-2000)

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