Application for Non-Human Use of Radioactive
Material - Training, Experience, Laboratory Staff,
and Equipment Addenda
Download the RS-01B Word document form
Instructions for
Completing the form
Please
return the completed Form RS-01B to: Radiation
Safety Division CYF G102,
Phone: 500-5840
Section
7: Training in the safe use of radiation
All pertinent training in Parts A-F should
be completed by the Applicant with the name indicated. Please
list the university or college where the radiation safety training
was received. Also note the duration of the training
and whether it was on-the-job or formal classroom training.
Section
8: Laboratory/clinical experience
using radiation sources
List prior experience utilizing the
requested radionuclides, activities, and protocols described
on the RS-01A application (e.g. 32 P, 0.250 mCi, sequencing,
2 years, Texas A&M Univ.).
If an applicant has no direct
experience with the protocol or radionuclide, another Authorized
User may submit a Memorandum of Supervision stating that
the proposed protocol will be performed under their direction
until the applicant becomes proficient with that technique.
Section
9: Laboratory personnel using
radiation sources
List all laboratory staff working with radiation
sources. Laboratory
personnel working with radiation must complete the RS-02 (Training
and Experience) and RS-03 (Previous Exposure History) forms
which are available from the Radiation Safety Division.
All
persons working with radiation sources must be informed of
the specific hazards of their work. They should initial
the RS-01B indicating that they have been informed by the applicant
of the potential radiation hazards present in the laboratory.
Section
10: Radiation detection instrumentation
List any portable
survey instruments used by or available to the laboratory
(example. Ludlum Model 3, SN: 12345). Also,
list any analytical counting equipment used by or available
to the laboratory (example: Liquid Scintillation Counter,
Packard Tri-Carb Model 4430). Also include the last date of
calibration for instruments and counting equipment.
Section
11: Certification
Sign and date on the appropriate
line indicating that all information on the application
is true to the best of your knowledge and that you intend to
comply with the authorization conditions and restrictions
imposed by the Radiation Safety Committee at the University
of Texas Health Science Center at Houston.
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