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Radiation Control (RC) Forms

ALARA Overview

NRC Regulatory Guide 8.29 Instruction Concerning Risks From Occupational Radiation Exposure

Florida DOH Notice to Employees

RC-1 “Statement of Radiation Safety Training and Related Experience”

This form must be accompany request for authorization to possess radioactive materials as a Authorized User or Associate Investigator.
RC-2 “Request for Radiation Monitoring/Cancellation”
This form is to be filled out by personnel to request dosimetry to monitor exposure during work with radioactive materials.  It should be sent to the Radiation Safety Office at least two weeks prior to needing the dosimeter for work.  Training documentation is required.

RC-3 “Application for Authorization to Possess and Use Radioactive Material”

This form must be submitted to the Radiation Safety Officer and approved by the State of Florida prior to UCF faculty members using, possessing, transferring, or receiving radioactive materials.  It can take from one to three months to receive State approval.
RC-4 “Application to Register Ionizing Radiation Producing Machines”
This form must be submitted to the Radiation Safety Officer and approved by the State of Florida prior to UCF faculty members using, possessing, transferring, or receiving ionizing radiation producing machines.  It can take from one to three months to receive State approval.
RC-5 “Radioactive Material Transfer”
This form will be filled out by the Radiation Safety Office upon receipt of radioactive materials.  The Authorized User or designee will sign the form and keep a copy on file.
RC-6 “Isotope Log Inventory”
The Authorized User must maintain this form for each radioisotope ampoule.  In addition to tracking the use of isotopes, the form is also used to compare dates of surveys and wipe surveys with the date of isotope use.  The inventory log is to be posted at area of vial storage
 RC-10 “Radioactive Waste Disposal Log”
This form is for use by the Radiation Safety Office to track the disposal of radioactive waste.
RC-13 “Laboratory Evaluation”
This form will be used by the Radiation Safety Office to perform inspections of the laboratory/storage areas where radioactive materials are used and stored.

RC-14 “Radioactive Material Contamination /Wipe Survey Report”

This form is used to perform instrument survey and wipe tests at the frequency prescribed on the form.  A copy will be kept by the Authorized User.
RC-15 “Instruction Concerning Prenatal Exposure”
An information packet regarding prenatal exposure that is distributed during training.  Prior to their work, all persons who will be working with radioactive materials or ionizing radiation producing machines must sign this form, verifying they have read and understand the information in the packet. The Radiation Safety Office will keep it on file.

NRC Regulatory Guide 8.13 Instruction Concerning Prenatal Radiation Exposure

RC-16 “Declaration of Pregnancy”
This form is used by the Radiation Safety Office to insure timely and efficient monitoring of  pregnant individuals.  It will be kept on file at the Radiation Safety Office.
 All records pertaining to radioactive materials kept by the Authorized User must not be disposed of.  When the User terminates his/her radioactive material use or leaves the University, the records shall be transferred to the Radiation Safety Office.