Report Contamination Surveys for Unsealed Radiation Use

All laboratorieslicensed to useunsealed radioactive materials must submit the results ofcontamination surveys via this website.After completing the form click on “Submit” to send the form to the ֱ Radiation Safety Office.

Please list ALL rooms where surveys were performed in a given week. In accordance with the Radiation Safety Handbook you must use a blank/background vial (containing only cocktail) each time you perform surveys. The results of the background vial must be entered on the form. If contamination (any result greater than twice background) is found you need to complete the section for contamination including date and resurvey results. Cleaning and resurveying should take place as soon as the contamination is found to reduce to the risks of exposure and spreading contamination.

Once the survey page has been completed and saved, pleaseprint the page and keep it in your survey logbook with the appropriate LSC print outs. Any maps or lists of areas surveyed should also be included. Radiation Safety will be performing reviews of all survey logbooks during annual Lab Audits.

Indicates required field
Today's date
Please enter your full name (first and last)
Last name of the PI authorized by the ֱ Radiation Safety Committee for work involving radioactive materials.
Name of the building in which the surveys were taken.
Room numbers for all rooms surveyed this month.
Year
Isotope Currently in Possession
Materials Actively Used
Were radioactive materials actively used at any point during this reporting month?
Enter the date of survey completed for monthly survey or for the first week radioactive materials were used during this reporting month.
Enter the counts per minute (cpm) value for your BLANK vial from the LSC results.
Double the cpm reading of the BLANK vial results from the LSC. (no decimal places)
Week1 Above Twice Background
Did any of the wipes taken turn out to more than twice your BLANK sample?
Enter the date of survey completed for the second week radioactive materials were used during this reporting month.
Enter the number of wipe smears taken and analyzed during this survey.
Enter the counts per minute (cpm) value for your BLANK vial from the LSC results.
Double the cpm reading of the BLANK vial results from the LSC. (no decimal places)
Week2 Above Twice Background
Did any of the wipes taken turn out to more than twice your BLANK sample?
Enter the date of survey completed for the third week radioactive materials were used during this reporting month.
Enter the number of wipe smears taken and analyzed during this survey.
Enter the counts per minute (cpm) value for your BLANK vial from the LSC results.
Double the cpm reading of the BLANK vial results from the LSC. (no decimal places)
Week3 Above Twice Background
Did any of the wipes taken turn out to more than twice your BLANK sample?
Enter the date of survey completed for the fourth week radioactive materials were used during this reporting month.
Enter the number of wipe smears taken and analyzed during this survey.
Enter the counts per minute (cpm) value for your BLANK vial from the LSC results.
Double the cpm reading of the BLANK vial results from the LSC. (no decimal places)
Week4 Above Twice Background
Did any of the wipes taken turn out to more than twice your BLANK sample?
Enter the date of survey completed for the fourth week radioactive materials were used during this reporting month.
Enter the number of wipe smears taken and analyzed during this survey.
Enter the counts per minute (cpm) value for your BLANK vial from the LSC results.
Double the cpm reading of the BLANK vial results from the LSC. (no decimal places)
Week5 Above Twice Background
Did any of the wipes taken turn out to more than twice your BLANK sample?
Specific location of contamination within laboratory (i.e. Fume hood, floor, lab bench, sink, etc) for FIRST sample above twice background
Re-survey date for FIRST sample above twice background
Specific location of contamination within laboratory (i.e. Fume hood, floor, lab bench, sink, etc) for SECOND sample above twice background
Re-survey date for SECOND sample above twice background
Specific location of contamination within laboratory (i.e. Fume hood, floor, lab bench, sink, etc) for THIRD sample above twice background
Re-survey date for THIRD sample above twice background
Specific location of contamination within laboratory (i.e. Fume hood, floor, lab bench, sink, etc) for FOURTH sample above twice background
Re-survey date for FOURTH sample above twice background
Specific location of contamination within laboratory (i.e. Fume hood, floor, lab bench, sink, etc) for FIFTH sample above twice background
Re-survey date for FIFTH sample above twice background