Radiation Badge Application

Please complete all fields below to apply for enrollment in the University of New Mexico dosimetry program.


As part of your application, you must also complete Learning Central item HSC 181 or contact RadBadge@salud.unm.edu to arrange for training in the care and use of individual monitoring devices. If you are a physician who independently operates fluoroscopy, you will also be required to complete HSC 183.


Note: Do not use this form to request a replacement for a lost dosimeter. If you have an existing dosimeter subscription and are in need of a new badge to replace one that is lost or missing, please submit a lost dosimeter form.


If you are in need of a fetal dosimeter, please contact RadBadge@salud.unm.edu to arrange for a consultation.

Application Type*

Select "Enroll" f you are a new hire or "Reinstate" if you were previously monitored for radiation exposure(s) at the University of New Mexico.

Enter your 9-digit UNM ID number beginning with a 1, 4, or 8. This number will be used in place of a social security number as your unique identifier for radiation dose reporting.

Select or enter value
Caret IconCaret symbol

Please provide your full job title if not available in the drop-down list above.

Enter the best phone number to reach you if there are questions about your application.

Phone

Select the physical location where you will receive the bulk of your radiation exposure.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of the UNM Comprehensive Cancer Center.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of Carrie Tingley Hospital.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of a UNM dental clinic.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of UNM main campus.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of Outpatient Surgery & Imaging Services.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of an outlying clinic or office.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of Sandoval Regional Medical Center.

Select
Caret IconCaret symbol

Please select the series to which you should be assigned based on your indication of UNM Hospital.

Select
Caret IconCaret symbol
Select desired ring dosimeter size*
Select which hand on which ring dosimeter will be worn*

Ring dosimeters should be worn on the hand likely to receive the highest radiation dose.

Are you a traveler or non-permanent staff?*

Are you visiting a department to observe, shadow, or as part of a short-term rotation?*

Will you be working with radioactive material (RAM)?*

Please note that optically-stimulated luminescent (OSL) dosimeters are only suitable for measuring external radiation doses from photons (x-rays and gamma rays) and high-energy beta particles. Select "No" if you will not be working with RAM or working exclusively with alpha-emitting compounds or beta-emitters <150 keV.

Will you be working with or around x-ray machines?*

Select all that apply.

Select
Caret IconCaret symbol
Are you a physician who will independently operate fluoroscopy machines (stationary or portable c-arms)?*
Do you currently have another job outside of UNM where you are assigned a radiation badge?*

UNM will need to request your year-to-date dose to ensure you have not exceeded the annual regulatory limits from ALL occupational exposures during the current calendar year that began January 1.

Were you previously monitored for radiation exposure at a non-UNM facility during the CURRENT calendar year (beginning January 1)?*

Since you previously wore a radiation badge at another non-UNM facility during the current calendar year or in the past, UNM must request your prior occupational dose.

Drag and drop files here or

Please review your responses and click "Submit" to send your application to UNM Radiation Safety for review and processing. Mark the "Send me a copy of my responses" box to save a copy of your submission.

Privacy Notice|Report Abuse