fsu.edu | radiation safety


	Units Building and Construction Safety Industrial Hygiene Research Support and Environmental Compliance Risk and Insurance Services Emergency Management Building Code Fire Safety Biological Safety Chemical Safety Laboratory Safety Radiation Safety Risk Management Workers' Compensation	Policies and Procedures OP-G-1 Environmental Health & Safety OP-G-2 Industrial Hygiene OP-G-3 Biological Safety OP-G-4 Chemical Safety OP-G-5 Laboratory Safety OP-G-6 Radiation Safety OP-G-7 Building and Construction Safety OP-G-8 Fire Safety OP-G-9 Emergency Management OP-G-10 Insurance, Risk Management, and Workers' Compensation OP-G-11 Training	Forms General Insurance Fire Safety Industrial Hygiene Building Code Administration Research Support and Environmental Compliance Biological Safety Chemical Safety Laboratory Safety Radiation Safety Workers' Compensation	Training Available Classes Online Training Training Calendar Request Training	Miscellaneous Newsletter Safety Links

Personnel Dosimetry Application EHS 10-3

Use this form only if you have never received an occupational dose at another institution. Otherwise, you must fill in this form: doc format or pdf format.

First Name
Middle Initial
Last Name
Email
Gender	Female Male
Employee ID
Date of Birth
PI or Supervisor
Campus Phone
Status

Have you been issued dosimetry before at FSU?	No Yes

Will you be handling >1mCi of beta emitting isotopes with a maximum beta energy >1MeV	No Yes

Have you received occupational dose at another institution during this calendar year? (*See Note)	No Yes

Have you ever received occupational dose at any other institution? (*See Note)	No Yes

*Note: If you answered "Yes" to either of these two questions, you will be asked to fill out an additional form in order to comply with State and Federal regulations.

Approximately how long will you need a dosimeter? Please indicate	# of weeks , # of months , or 6 Months

Address where you can be reached after you leave FSU:


Comments


Instructions Wear whole-body dosimetry with the window towards potential radiation sources, and between your waist and neck. (If you are assigned a ring TLD and you wear disposable gloves, wear it under your glove with the element towards the radiation source). Always wear your assigned dosimetry as required while working in designated radiation areas or handling radioactive materials. Never wear dosimetry assigned to another user and do not allow others to wear your assigned dosimetry. When not wearing the dosimetry, leave it in a non-radiation area, preferably in designated locations. Avoid taking dosimetry home. If you do, protect it from diagnostic X-rays, excessive heat, etc. If such exposure occurs, or if it is lost, notify the Radiation Safety Office as soon as possible. Obey all safety rules specified in the FSU Radiation Safety Manual and any additional instructions given by your PI or Radiation Safety Office personnel, when working in radiation areas or handling radioactive materials. If using radioactive materials, please contact the Radiation Safety Office in order to ensure that the training and experience section of your PI's Proposal has been completed authorizing your activities. I have read and understand the above instructions and request that appropriate dosimetry be assigned to me.