Application for Radioisotope Use

Application for Radioisotope Use

Use this portal to apply to become a radiation authorized user. If you have any troubles with this form, please email rsc@olemiss.edu.

Today's Date*

Name*

Name of personnel requesting authorization

Department*

Building*

Room #*

Name of Principal Investigator*

What isotope(s) will be used?*

What is the physical form of the radioisotope?*

What is the maximum activity of the radioisotope(s)?*

Is access limited to personnel authorized for radiological work?*

Please select yes or no

Select or enter value

Are work surfaces non-absorbent and smooth?*

Select or enter value

Are floor surfaces non-absorbent and smooth?*

Select or enter value

Is the ventilation system arranged as not to create a hazard for others?*

Select or enter value

Containment provisions for radioactive materials:*

Select all that apply.

Select or enter value

Containment provisions for radioactive waste:*

Select all that apply.

Select or enter value

Experimental and Emergency Procedures*

Please upload the detailed Experimental Procedures involved AND Emergency Procedures (reference Section 17 in the Radiation Safety Manual).

Drag and drop files here or

Send me a copy of my responses