Forms

 

RPR 1A Radiation User Training & Personal Data

RPR 1B Request for Radiation Exposure History

RPR 1C User Termination Checklist

RPR 2A Responsible User’s Training & Experience

RPR 2B Radioactive Material Use Application

RPR 2C Radioactive Machine Use Application

RPR 2C-CL Analytical X-Ray Machine Checklist

RPR 2D Application for Use of Radiation

RPR 11A Contamination Survey – Portable Instrument

PRP 11B Contamination Survey – Wipe Tests

RPR 12A Urinalysis Screening Assay

RPR 12B Urinalysis Verification Assay

RPR 12C I-125 Thyroid Monitoring Report

RPR 12D I-131 Thyroid Monitoring Report

RPR 13A Radioisotope Package Arrival Report

RPR 13B Radioisotope Receipt and Verification

RPR 13C Radioisotope Disposition Record

RPR 13D Radioisotope Disposal Log

RPR 14LQ Radioisotopes Limited Quantity Shipment

RPR 14IS International Excepted Quantity Shipment

RPR 27A Nuclear Medicine Evaluation Checklist

RPR 28A Radiopharmacy Evaluation Checklist

RPR 29A Cyclotron/Radiochemistry Laboratory

RPR 30A Analytical X-ray Machine Safety Inspection

RPR 32A Particle Accelerator Safety Inspection

RPR 43A Authorization for Radiation Use

PRP 46A External Exposure Investigation Report

RPR 46B Internal Exposure Investigation Report

RPR 49A Request for Withdrawal from External Radiation Dose Monitoring Program

RPR 50A Laboratory Evaluation Checklist

RPR 50B Total Contamination Survey

RPR 50C Removable Contamination Survey

RPR 50D Exposure Rate Survey

RPR 50E Radionuclide Laboratory Evaluation Report

RPR 51A Sealed Source Leak RecordRevised

RPR 55ID Receiver Identification and Authorization

RPR 55A Common Carrier Shipment

RPR 55RW Radioactive Waste Shipment

RPR 55EUV Exclusive Use Vehicle Shipment Survey and Driver Instructions

RPR 55LSA Exclusive Use LSA Shipment

RPR60A Nuclear Medicine Evaluation Checklist