Health Protection Office

For general instructions on using Acrobat E-forms version click HERE

Radiation Protection

Medical Radiation Protection Committee (MRPC)
Applications for the Medical Research Use of Radiation

Application for the Medical Research Use of Radiation (Long Form)
Use this form when applying for approval for human subject research use of radioactive materials, radiation exposure, or lasers.
  • PC Microsoft Word file  (humanuse1.doc)

    • Application for the Medical Research Use of Radiation (Short Form)
    Use this short form when applying for approval for human subject research proposals involving radiation exposure from only routine diagnostic x-rays of the extremities, head, neck, teeth, chest, or DEXA bone density scans.
  • PC Microsoft Word file  (humanuse2.doc)

    • Hospital Radiation Safety Review Group (HRSRG)
    Applications for Routine Clinical Use of Radioactive Materials

    Application for Clinical Use of FDA Approved Radiopharmaceuticals
    Use this form when applying for approval for routine clinical use of an FDA Approved radiopharmaceutical.
  • PC Microsoft Word file  (approveradio.doc)

    • Application for Clinical Use of Compounded Radiopharmaceuticals
    Use this form when applying for approval for routine clinical use of a compounded radiopharmaceutical.
  • PC Microsoft Word file  (compoundradio.doc)

    • Application for Clinical Use of Radioactive Material Devices
    Use this form when applying for approval for routine clinical use of a radioactive device.
  • PC Microsoft Word file  (RAMdevices.doc)

    • Basic Science Radiation Protection Committee (BSRPC)
    Applications for the Non-Medical Use of Radioactive Materials

    Authorization Request - Form 1
    Use this form when making initial application for approval to use radioactive materials for non-medical purposes.
  • PC Microsoft Word file  (form1.doc)

    • Methodology Amendment - Form 2
    Use this form to add radionuclides and/or new methodologies to an existing non-medical authorization.
  • PC Microsoft Word file  (form2.doc)

    • Administrative Amendment- Form 3
    Use this form to amend possession limits of previously approved radionuclides, use and storage locations, and/or add/delete personnel authorized to work with radioactive materials.
  • PC Microsoft Word file  (form3.doc)

    • Application Cancellation Form for Basic Science Use of Radioactive Materials
    Use this form to cancel existing applications for non-medical use of radioactive material.
  • PC Microsoft Word file  (form4.doc)

    • Dosimeter Add Form
  • PC Microsoft Word version  (daddform.doc)

    • Dosimeter Change Form
  • PC Microsoft Word version  (dchform.doc)

    • On-Campus Radioactive Material Transfer Form
  • PC Microsoft Word file  (form5.doc)

    • Pregnancy Declaration Form
  • PC Microsoft Word version  (pregnancy.doc)

    • Biological Safety

    Bloodborne Pathogen Annual Program Review
  • Microsoft Word version  (annualprogrev.doc)

    • Bloodborne Pathogens Incident Form
  • Microsoft Word version  (incidentform.doc)

    • Bloodborne Pathogens Exposure Statement
  • Acrobat E-forms version  (bbpes.doc)

    • Recombinant DNA - rDNA Registration Document
  • Adobe Acrobat version  (rdnaregform.PDF)
  • Microsoft Word version  (rdnaregform.doc)

    • Waste Management

    Radioactive Waste Pickup Request
  • Online Form  (radwastepickup.htm)

    • Hazardous Waste Pickup Request
  • Online Form  (hazwastepickup.htm)


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