UCD COMMITTEE ON IONIZING RADIATION

Health and Safety Division, Office of the Vice Chancellor for Research, Box F-484

Application to use the Co-60 Irradiator

 

I.

Principal Investigator

Faculty Position

Department

Principal Investigator must be present during the first two times a new worker operates the irradiator. Direct supervision must continue until the Principal Investigator is certain that the worker is able to operate the irradiator safely

II.

Name

                  Date completed Training

                (for help call HSD at x40345)

Modules

     Irradiator (Co-60)
a.
b.
c.

*All workers listed in this section must have already completed the required UCD modular radiation safety training and the Co-60 irradiator specific training.

Description: ( Please describe the estimated dose, proposed irradiating time, frequency of use, type of specimen being irradiated (animals, cells, etc.), handling steps (how will you transport the material from and to the irradiator facility), safety precautions (where will you wait when samples are being irradiated, will the PI be present during irradiation time to observe workers listed under the PI's authorization), why do you need to use the irradiator (what are you trying to accomplish), and any other relevant information concerning the use of the irradiator).

 

By submitting this form, I   agree that the use of the Co-60 irradiator as a result of this application will be only as specified above, and in accord with the guidelines of the HSD, Radiation Safety Manual, as well as all other applicable UCD policies and procedures, the UCD radioactive materials license, and state and federal regulations.

VI.  Date:   PI's telephone ext. PI mail container