SYRACUSE UNIVERSITY RADIATION PROTECTION PROGRAM APPLICATION FOR USE OF RADIOACTIVE MATERIALS

Transcription

1 SYRACUSE UNIVERSITY RADIATION PROTECTION PROGRAM APPLICATION FOR USE OF RADIOACTIVE MATERIALS Please submit the completed application form and any attachments to the Environmental Health & Safety Services Office, 029 Lyman Hall, Attention: Radiation Safety Officer or to Section One - Applicant Information A. Principle Investigator (Supervisor): SU ID: Title: Department: Office Phone#: Lab Phone #: Cell Phone #: B. A copy of your Curriculum Vitae must be provided with the application. Have you attached a current copy to the application? Yes No C. Do you have previous experience in using radioactive materials? Yes No If Yes, please describe (include locations, dates, process descriptions, isotopes and quantities): Section Two - Personnel List all personnel who will use radioactive materials under your supervision (use additional pages as necessary). All individuals who will work with radioactive materials at SU must complete the Radioactive Material Worker Training Program prior to their use of radioactive materials. Name SU ID# Cat.* Isotope(s) Used Radiation Worker Status** Years of Experience *Graduate Student (G) Undergraduate Student (S) Employee (E ) Other (O) **Indicate Status: Approved, In-Training, or Not Approved EHSSO USE ONLY Application Number: Amendment Number: Date Received: Date To RSC: Date Approved:

2 Page 2 Section Three - Radioactive Material Possession Limits Indicate each nuclide to be used, the maximum amount of each nuclide that will be needed to be possessed in the laboratory at any one time, and the maximum activity of each nuclide to be used in any single experiment (include a decimal point in each value). Refer to the table of Control Unit Quantities in Section 10.4 of the Radiation Protection Program Handbook to determine the number of control units in the activity requested. Also indicate the physical (i.e. gas, liquid, powder, etc.) and chemical form of the each nuclide s stock material. Use additional pages as necessary. Maximum Possession Limit Limit Per Experiment Nuclide MicroCurie Control Units MicroCurie Control Units Physical/Chemical Form Section Four - Nuclide Justification If you have requested to use any long halflife (halflife greater than 90 days) nuclides in Section Three above, a justification of your need to use them must be provided below. This justification must demonstrate that a non-radioactive or short halflife radioactive alternative is not reasonably available or substitutable.

3 Page 3 Section Five - Operations A. Describe the overall scope of your proposal: B. Estimate the expected duration of your proposal: C. Provide a procedure(s) for each operation involving radioactive materials to be carried out under this proposal. The procedure(s) must be sufficiently detailed for evaluation of the associated hazard and must include: quantities of radioactive materials to be used, chemicals to be used, and steps to be taken to minimize the hazard (i.e. shielding, gloves, fume hood, etc.). Additional sheets should be attached as necessary.

4 Page 4 Section Six - Equipment A. Check the equipment that is available to your radioactive material workers: Protective gloves Lab coat Absorbant paper Radiation signs/tags Shoe covers Shielded storage Handling tongs Dosimeters Survey meter Mechanical Pipette Fume Hood Respirator Lockable storage Shielding Glove box Other - describe: B. Check the types of radiation monitoring equipment that will be available to you radioactive material workers and provide the make and model of each type available: GM -Thin window pancake Make: Model: GM -Thin end window Make: Model: Thin crystal Sodium Iodide Make: Model: Liquid Scintillation Counter Make: Model: Sodium Iodide Well Counter Make: Model: Other: Make: Model: Section Seven - Facilities A. List all rooms where any radioactive material under your possession will be used or stored. Include a floor plan of each room which clearly identifies the location of radioactive material use and storage areas and any other large pieces of equipment (i.e. fume hood, centrifuge, refrigerator, etc.) to be used in conjunction with radioactive materials. B. Will any of these areas be accessible to non-radiation workers: Yes No If yes, please indicate which locations and the types of individuals that will have access to them (i.e. custodians, students, dishwashers, etc.):

5 Page 5 APPLICATION FOR USE OF RADIOACTIVE MATERIALS Section Eight - Radioactive Waste A. Please estimate the type(s) and quantity(s) of radioactive waste that your laboratory will generate (as applicable). Liquid: Chemical Composition Est. Monthly Volume L/Month Solid: Scintillation Vials: Animal Waste: Other: Scintillation Cocktail Name ft 3 /Month L/Month ft 3 /Month B. Special authorization is required prior to generation of a Mixed Waste (see section 3.6 of the Radiation Protection Program Handbook for details on mixed wastes). Will you generate any wastes that are or may be classified as a mixed waste (i.e. radioactive wastes which contain hazardous chemical wastes): Yes No If Yes, please describe these wastes in detail and provide an explanation as to why the generation of such waste is unavoidable (use additional sheets as necessary). C. Will radioactive waste minimization techniques be employed in your laboratory whenever possible? Yes No If Yes, what techniques will be used: Limit purchases to minimum quantity needed Handle radioactive materials carefully to prevent unnecessary contamination Employ volume minimizing techniques in procedures Carefully plan radioactive material use to avoid any unnecessary contamination Consider alternative, non-radioactive methods Others (explain): D. If allowed by EHSS, will any radioactive waste be disposed through the sewer system? Yes No If Yes, Estimate the total monthly activity for each isotope that will be disposed through the sewer system? (Reminder: all materials disposed must be readily soluble in water) Isotope Activity (mci) Chemical Composition

6 Page 6 APPLICATION FOR USE OF RADIOACTIVE MATERIALS Section Nine - Radiation Exposure Hazard Evaluation A. Describe the expected radiation dose to personnel from both internal and external exposure. Highlight any operation which could in any way (i.e. accident) produce excessive radiation exposure or contamination. Internal Exposure: External Exposure: B. Describe the exposure that is likely to be present in adjacent non-controlled areas and steps that will be taken to ensure that exposures are kept below the public dose limits (refer to Section of the Radiation Protection Program Handbook) Section Ten - Radiation Monitoring (refer to section 2.9 of the Radiation Protection Program Handbook) A. Ambient Exposure Monitoring What is the highest ambient exposure expected in the laboratory? What steps will be taken to ensure the ambient exposure in the laboratory is kept as low as reasonably achievable? Will Ambient Exposure monitoring be performed and documented on a monthly basis? Yes No If No, explain: B. Removable Contamination Surveys At what frequency will removable contamination wipe testing be performed? Monthly Weekly Other (explain): At what action level will contamination be remediated: How will your wipe tests be analyzed: Lab LSC (make/model) EHSSO LSC Other (describe): Note: if other than EHSS LSC is checked, attach a detailed description of the quality assurance procedures that will be performed including performance frequency and reference sources to be used C. Describe the procedure that will be used by your personnel to monitor for personnel contamination, including the equipment to be used. Will this procedure be followed after each use of radioactive materials? Yes No If No, explain.

7 Page 7 Section Eleven - Security Describe the steps that will be taken in your laboratory to prevent the unauthorized removal of radioactive materials (i.e. locked storage cabinet). Section Twelve - Assurance Statement I acknowledge responsibility for all radioactive materials used in my laboratory. I agree to comply with all Federal, State and local rules and regulations applicable to this application and radioactive materials. I have read and have a copy of the Syracuse University Radiation Protection Program Handbook. I agree to have this Handbook readily available to all persons using radioactive material in my laboratory. I also agree to have standard operating procedures for all operations proposed in this application available to all radioactive material workers working under my supervision. As radioactive material supervisor, I accept the responsibilities of the title as described in Section 1.3 Radiation Protection Program Handbook. I assume the responsibility of assuring that all individuals using radioactive material in my laboratory have completed the required radioactive material training program and have received the required supervised training. I also agree to assure that all exposures from radioactive sources used in my laboratory are kept as low as reasonably achievable. Furthermore, I will assure that all radioactive material use conducted in my laboratory will be in accordance with the terms and conditions of my application, the Radiation Protection Program Handbook, the University s radioactive material license and applicable rules and regulations. I am aware that any additions or modifications to approved procedures or radioactive material use in my laboratory that could potentially increase or modify the radiation hazard or introduce a new hazard must be approved by the Radiation Safety Committee. I certify that all information provided and all statements made in this application are true and complete to the best of my knowledge. Signature of Applicant Date: