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 Applicaitons.
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 Applicaitons.
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 Applicaitons.
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 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  

 

Resources

Documents and Articles

Websites

Videos

The following videos are available for check out from the Carlson Health Sciences Library (HSL). You may contact them at (530) 752-8041 if you have any questions about the videotapes.

  • Radionuclide Hazards: Safety in the Research Laboratory (12 minutes): A basic review of the fundamentals of radiation safety. Also includes a demonstration of protocols used in biological science research, use or survey instrumentation and safe work practices, etc. (Howard Hughes Medical Institute); Call # QY 23 R129
  • X-ray Diffraction Hazards (9 minutes): For non x-ray diffraction users. (Howard Hughes Medical Institute) 2 copies; Call # WA 485 X83