Radioactive Materials Purchase Approval Form

This form is used to request EH&S approval prior to placing a radioactive materials order with an outside vendor

EH&S Thankskiving Holiday Schedule:

The Radiation Safety Office will be closed on Friday, Nov 27th. We will be unable to receive shipments of Radioactive Materials.

Take care and have a great holiday!

Instructions:

1.   Complete ALL fields EXCEPT the SHADED areas

2.   Send the form to EH&S by clicking on the submit button below

3.   EH&S will review the Principal Investigator's authorization and the laboratory possession limits. HSD will provide a requisition (Reference) number for each isotope and compound requested by return email within two hours (next business day if form submitted after 3:00 PM). If you need a requisition (Reference) number immediately, please call 724-0345.

4.   Upon receiving a Requisition (Reference) Number from EH&S, you create a Department Purchase Order (DPO) and place your order directly with the vendor of choice.

5.   Do not place the order with the vendor until EH&S provides a requisition (Reference) number by return email. Please inform your vendors that isotope shipment must be identified by the Principal Investigator and the requisition (Reference) number on both the address label and the packing list.

6.    Please click here for a downloadable version of this form.

Note: If you have any questions regarding this form, please call EH&S at 303/724-0345 .

All Radioactive materials used at the Anschutz Medical Campus must be delivered to the following address:

Health & Safety Support Facility

13178 E. 19th Ave.

Aurora, CO 80045

Date:

Principal Investigator Name: 
Requestor Name:
Phone #:

Email:

Campus Box:

Bldg:

Room:

 

User's Name Vendor Unit (# of Vials) Catalog Item # Compound Isotope Activity per Unit (mCi) Requisition (Reference) #
For HSD use only
For HSD use only
For HSD use only

For Standing Purchase Requests only:  

Vendor

Start Date

End Date

Activity per shipment (mCi)

Total Activity (mCi)

Compound

Isotope

Requisition (Reference) Number

For HSD use only

For HSD use only 

For HSD use only

 Please Click Only ONCE on the Submit Button Below

 

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