Application for Non-Human Use of
Radioactive Material
Download the form Word document)
Instructions for Completing the Form
Please
return the completed Form RS-01A to:
Radiation Safety Division; CYF
G102
Phone: 500-5840
Section 1: Applicant
data
Complete the required administrative information for
the proposed applicant.
Section 2: Radionuclide
and activity data
Please complete one RS-01A for each requested radionuclide.
Therefore, if the applicant desires authorization for multiple
radionuclides (e.g. 32 P, 3 H, 125 I, and 35 S) multiple
copies of the RS-01A must be completed. This affords
the Radiation Safety Committee the ability to review each
radionuclide independently.
Possession
Limit: |
This
is the maximum activity of this radionuclide to be
possessed at any time. This
quantity is the total inventory retained by the investigator
including radioactive waste held in the laboratory.
In general, Possession Limit = 2 x [Order Limit]. |
Per Order Limit: |
This is the maximum activity of this radionuclide to
be ordered at any time. |
Annual Limit: |
This is the maximum activity to be
ordered per calendar year. In general, Annual
Limit = [Number of Protocols per Year] x [Order Limit]. |
Please enter the chemical
and physical form of the proposed compound. Gaseous
radioactive material (e.g. 41 Ar and 133 Xe) may require supplemental
approval from the Texas Department of Health.
Section 3: Radioactive
material use location(s)
Record the building, laboratory number,
and phone number where radioactive material will be used or
stored.
Section 4: Radioactive
material use protocol
Briefly summarize the protocol/use of
radioactive material. Estimate
the activity to be used each time a procedure is performed
and the frequency of the procedure. Attach additional
sheets, if necessary.
- Description
of protocol: Probes, sequencing, radioimmunoassay
kits, western plots, etc.
- Activity
per procedure: For example, 50mCi
per procedure.
- Frequency
of protocol: For example, 1 per week, 1 per month.
Section
5: Storage and handling facilities
for radioactive material
Briefly describe shielded storage
facilities, special handling apparatus, external dose
reduction procedures, radioactive material contamination
control procedures, and security for radioactive material.
- Storage
location: Bldg: Lab Number: refrigerator,
freezer, hood, etc.
- Protocol performed behind Plexiglas or
lead shielding, as necessary. Utilization of approved
chemical fume hoods, if appropriate.
- Routine contamination
surveys will be performed in accordance with the Radiation Safety Manual .
- Security
measures will be employed to prevent unauthorized
use of radioactive material.
Section
6: Need
for off-site shipment of radioactive materials
Briefly describe
any radioactive material that will likely be transported to
other institutions from the UTHSC-H and for what purpose.
If none likely, indicate "none."
Section 6a: Radioactive
waste disposal
Record the appropriate disposal method on the
application for the physical form and half-life of the radioactive
waste.
| Physical
Form |
Half-life |
Disposal Method |
| Liquid Waste |
all types |
Segregate by radionuclide and collect in one-gallon
containers provided by the EPD. [Aqueous wastes
only.] |
| Solid Waste |
<300 days |
Dispose in radioactive waste alcoves. |
| Solid Waste |
>300 days |
Segregate by radionuclide and dispose in radioactive
waste alcoves. |
| LSC Vials |
all types |
Segregate by radionuclide and dispose in radioactive
waste alcoves. |
| Carcass Waste |
all types |
Dispose in animal carcass freezer MSB B.004. |
| Mixed Waste |
all types |
Disposal method determined on a case-by-case basis.
[Non-aqueous wastes] |
|
