How to Fill Out Authorization Application Forms


To download each form, click the Rad Forms link to the right. For additional instructions on filling out each form, click the form type below:

 

Application Initiation Page

An Application Initiation Page must be completed for all applications. All applications are tracked by Authorization Number and application date. Complete the Authorization Number and application date at the top. For new user applicants, an Authorization Number will be assigned at application review. Indicate the application type, complete the personal data, and sign the AU statement to confirm acceptance of responsibilities.

 

Authority Page

All AU’s must demonstrate administrative support for their authorization.  The Administrator responsible for the AU is based on the primary location of the AU's authorized work.  If the AU requests use of an area supervised by another administrator, then support for use of that area must also be obtained. For example, if the AU does not have a liquid scintillation counter for monthly swipes and would like to use another AU's counter in a separate building, the AU in charge of the room in which the liquid scintillation counter resides must provide approval. The AU is responsible for completing the information on this page and obtaining the required signature(s).

Note to the Direct Supervisor: Signing of the Direct Supervisor Statement confirms acceptance by the Administrator of the responsibilities listed in Administrator Responsibilities. 

Note for Supervisor Support of other area: These sections must be completed when the AU applicant is requesting additional rooms in areas not supervised by the Direct Supervisor.  Signing of the “Supervisor for Other Area” statement confirms acceptance by the administrator of the responsibilities listed in Administrator Responsibilities.

 

Co-Authorization Authority Page

The Co-Authorization page is used when a Co-AU who will not be primarily in charge of the RAM spaces requested and associated requirements would like to work alongside a primary AU in an authoritative manner. In filling out this form, a primary AU is identified and provides support of the Co-Authorization. This form is typically used for clinical based authorizations or new AUs who cannot justify exemption from the training and experience requirements and need supervision.

The Secondary User is responsible for completing the information on this page and for obtaining the required signature(s).

Signing of the Primary User and the Primary User’s Direct Supervisor Statements confirms acceptance by the Primary User and the Administrator of the stated support.

 

Training and Experience Page

The RSC must review the training and experience of all individuals requesting authorization.  Criteria for acceptable training and experience are based on the proposed uses and amounts of radioactive materials.

Complete the personal data section.  This is for the AU applicant only. Document the type, date, and the duration of classroom (formal) training received on the listed topics, and indicate where the training was received. Document the type, date, location and duration of experience working with radioactive materials.

If the new potential AU does not meet the training and experience requirements, then additional 8 or 20 hour outside classroom training will be required. Reach out to your assigned HP for recommendations on outside formal classroom training.

 

Isotope Page

AUs must list requested isotopes and associated hazards. In addition to the Isotope Page, the AU must attach a Standard Operating Procedure describing the work being performed and addressing any radiation safety issues. All authorizations should have a current SOP on file.

Make sure to list each isotope that is being requested and include what form the isotope will be used. The most common forms are 'any,' 'generator,' or 'sealed source.' Additional forms that may be specified are activation byproduct, isotope kit, microsphere, seed, foil source, or slug. For each isotope requested, list a shipping and a possession limit in mCi. the order limit cannot exceed the possession limit of the specific authorization.

If generic procedures are used, identify them on the Isotope page. Generic procedures include Northern blot, Southern blot, Western blot, Hybridization, Soil moisture gauge, Iodinations, Soil density gauge, Gas chromatograph, electron capture foil use, etc. An SOP must still be attached if only generic procedures are being used, but the SOP does not need to be extensive.

If any special uses will be performed using the isotopes requested, descriptions of the additional controls and procedures for each condition should be included in the SOP. Make sure to indicate which special uses may occur by checking the box next to each option on the Isotope Page.

For help on addressing the special conditions in the SOP or the setup in the lab, refer to Radiation Safety Special Uses and Controls of RAM. If you need additional assistance in addressing Personal Protective Equipment concerns, see the Personal Protective Equipment page.

 

 

Radioactive Material Location Page

Each room or area will be reviewed and approved on an individual basis.  Rooms will be designated as restricted areas and the storage and use of radioactive materials is approved anywhere within the restricted area. Rooms may be categorized into the following types: radioactive work area, modified restricted area, common use area, storage only, transitory use only, or other.

Information concerning the surrounding areas is needed to help locate the room and to assess safety concerns (e.g., radiation levels, contamination control, etc.).  Information on the location of the radioactive work areas, storage areas, and other items on the identification key should be submitted with the application.  These locations may be moved anywhere within the restricted area without need of an authorization amendment.

 
MODIFIED RESTRICTED AREA

To request a modification of a restricted area:

  • Explain the purpose for requesting a modification of restricted area. 
  • Provide a floor plan of the entire restricted area and surrounding areas, identifying all doors securing the area, and marking what areas within the current restricted area will remain as the restricted area and what areas will remain the non-restricted.
  • Describe how security to the modified restricted area will be maintained. 
  • If food and drink are to be allowed in the non-restricted area, explain how the food and drink will be brought into that area, and how the food and drink will be kept completely out of the proposed restricted area.
  • Explain how all individuals having access to the modified restricted area will be trained to know and understand their responsibilities with regard to compliance with the special conditions governing the area.
  • Before the application is forwarded to the RSC, it will be reviewed and approved for by all Environmental Health and Safety (EHS) groups (i.e., Radiation Safety, Environmental Management Services, Industrial Hygiene/Biosafety, and General Safety).  If compliance issues are identified for any safety issue, the application for restricted area modification will not be supported.  Once a restricted area modification has been granted, any deficiency identified with compliance of the special conditions governing that area could result in the withdrawal of the approval. 

When filling out the form, make sure to:

  • Complete separate forms for each room or area. 
  • Provide a floor plan identifying the items listed in the Identification Key.  Plan should be a "to scale" floor plan with room dimensions. 
  • Provide information on how security of radioactive material will be maintained when authorized personnel are not present. 
  • Identify how the area will be used by checking the appropriate box(s) on the form (i.e. counting equipment only, transitory use only, etc.)

 

Radiation Survey Instrumentation Page

The purpose of this form is to ensure that the authorization has appropriate survey instrumentation available to detect both fixed and removable contamination. When filling out the form, make sure to provide requested information for each radiation survey meter and counting system.

Most all authorizations will need a Geiger-Mueller survey meter. A NaI survey meter may be required if authorized for iodine isotopes. If alpha emitters will be used, a ZnS survey meter may also be required. Counting systems will need to be used to determine removable contamination such as a Liquid Scintillation Counter.

If you need to obtain a radiation survey meter, contact your assigned HP for ordering information. If you need assistance in identifying a counting system for your use, contact your assigned Health Physicist for a nearby system location or information concerning the purchasing a new instrument.

Note: Uncalibrated survey meters or counting systems will not be approved for use in radiation safety surveys. See Surveys and Instruments for additional information on the use and calibration maintenance of your detection equipment.

 

Anticipated Transactions Page

The Anticipated Transactions Page allows EHS and the RSC to evaluate what transactions may be processed and the quantity of waste being generated.

For the Estimated Use section, list for each isotope the estimated number of shipments and total activity you anticipate receiving each calendar quarter. This is not a binding frequency, only an estimate. Do not include any transfers of radioactive material from other MU AU’s in this section.

If you plan to receive or transfer radioactive materials to other MU AU’s, provide the following information for each supplier or recipient in the Planned Transfers In or Out section:

  • Estimated generation of radioactive waste,
  • The type(s) of radioactive waste you anticipate generating: animal (carcass, waste and bedding), Mo-99 generator, liquid (jugs), liquid (stock), liquid (vials), seeds, solid, or other. 
  • The estimated volume per month for each waste type checked, and for each applicable isotope. 

Please estimate your waste generation volumes in the following units:

  • Solids in cubic feet, 
  • Liquids (jugs) in gallons,
  • Liquids (vials) in gallons,
  • Liquids (stock) in gallons,
  • Animal in kilograms,
  • Seeds in number of seeds.

Temporary Transfer of Authorization Page

If the AU does not feel they can fully supervise the authorization or has some extenuating circumstances, then the authorization may be transferred to another AU temporarily.

Provide the full name of the AU requesting the transfer and Authorization Number, describe the purpose for absence, provide the date that the transfer will begin and the anticipated end date. If additional space is needed for the purpose of absence, a letter may be attached to this form.

Provide requested information about the substitute AU taking over the authorization.

Note: Signing the Substitute AU Statement confirms acceptance of the stated responsibilities.

Provide the name and department of the Transferring AU's Direct Supervisor. 

Note: Signing by the Direct Supervisor indicates support for this temporary transfer.

 

Page last updated on April 2, 2019.