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Radiation Safety Manual Forms

Form 1 - Radiation Use Authorization Application Instructions
Form 2 - Radiation Use Authorization (RUA) Application
Form 3 - Radiation Use Authorization Statement of Experience
Form 3A - Machine Use Authorization Statement of Experience
Form 4 - Safety Protocol
Form 5 - Human Radiation Use Research Application
Form 6 - Guidelines for Completing Amendment/Renewal Request Form
Form 7 - Radiation Use Authorization Amendment/Renewal Request Form
Form 8 - Radioactive Materials Transfer Form
Form 9 - General Safety Guide for Outpatients Receiving Radioiodine Therapy 10-30 mCi
Form 10 - General Safety Guide for Hyperthyroid Outpatients Receiving Radioiodine Therapy Less than 10 mCi
Form 11 - Safety Guidelines for I-131 Therapy
Form 12 - Checklist for I-131 Therapy Room Preparation and Clean-up
Form 13 - Doctor's Orders for I-131 Therapy
Form 14 - Nursing Care for Patients Receiving Iodine-131 Therapy
Form 15 - Doctor's Orders for Patients Who Have Received P-32 Radionuclide Therapy
Form 16 - Checklist for P-32 Colloid Therapy
Form 17  - General Safety Guide for Outpatients Receiving Cu-67, Y-90 or Re-186 Therapy
Form 18 - Checklist for Cs-137, Ir-192 Brachytherapy
Form 19 - Doctor's Orders for Cesium-137, Iridium-192 or Iodine-125 Therapy
Form 20 - Uncontrolled Area Survey for Patients Treated with Cs-137, Ir-192 or I-131
Form 21 - Nursing Care for Patients Receiving Cesium-137 or Iridium-192 Therapy
Form 22 - Guidelines for Receiving Ir-192 at UC Davis Medical Center
Form 23 - Checklist for I-125 Seed Brachytherapy
Form 24 - Nursing Care for Patients Receiving I-125 Therapy
Form 25 - Recommendations for People Near Patients with Radioactive Iodine Implants
Form 26 - Procedures for Receiving I-125 Seeds at UC Davis Medical Center
Form 27 - Report on Radioactivity to the Funeral Director from the Radiation Safety Officer
Form 28 - Removed
Form 29 - MICU Exposure Time Guidelines
Form 30 - Radiation-Producing Machine (MUA) Application
Form 31 - Request for Shielding Design
Form 32 - Radiation-Producing Machine Amendment Form
Form 33 - Health Physics Event Form
Form 35 - Protocol Exemption from Radiation Use Committee Review
Form 36 - Diffraction/Fluorescence X-ray Safety Protocol
Form 37 - Cabinet X-ray Safety Protocol
Form 38 - Portable Radiography X-ray Safety Protocol
Form 39 - Radiography X-ray Safety Protocol
Form 40 - Fluoroscopic X-ray Safety Protocol
Form 41  - Bone Densitometer Safety Protocol (Non-Human Use)
Form 42  - Bone Densitometer Safety Protocol (Human Use)
Form 43  - Micro CT/CT Scanner Safety Protocol (Non-Human Use)
Form 44  - CT Scanner Safety Protocol (Human Use)
Form 45  - Spectroscopy Safety Protocol