Forms & Resources

Forms & Resources

The forms needed to apply for a Radiation Use Authorization or to make changes to an existing Radiation Use Authorization require your campus username and kerberos password to access. The interactive forms are on-line versions of the downloadable paper forms.

  • Forms

  • General Forms

    Radiation Safety Manual Forms

    Click on the Form Number to view and download the form.

    Form Number Title Note
    Form 1 Radiation Use Authorization (RUA) Application Instructions This form is in the process of being replaced at the UC Davis main campus. If you are located on the main campus, please visit UC Radiation for new RUA Applications.
    Form 2 Radiation Use Authorization (RUA) Application This form is in the process of being replaced at the UC Davis main campus. If you are located on the main campus, please visit UC Radiation for new RUA Applications.
    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 This form is in the process of being replaced at the UC Davis main campus. If you are located on the main campus, please visit UC Radiation for new RUA Applications.
    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 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 35 Instructions
    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