Get Dosimetry Request - Boston University - Bu

Completing the Dosimetry Request form for Boston University is an essential step for individuals requiring personnel monitoring while working with radiation. This guide provides a clear, step-by-step process to support users in accurately filling out the form online.

Follow the steps to successfully complete the Dosimetry Request form.

1. Press the ‘Get Form’ button to access the Dosimetry Request form and open it in your preferred document editor.
2. Fill in the date at the top of the form. Ensure accuracy as this may be used for record-keeping purposes.
3. Enter your full name in the designated fields: Last name, First name, and Middle initial.
4. Provide your Boston University ID number, department affiliation, and birth date in the corresponding sections.
5. Identify your permit holder or supervisor and include their name, followed by your position (faculty, staff, student, or other) and title.
6. Enter your email address and contact numbers for both office and lab phones to facilitate communication.
7. Indicate whether you will be using radiation or radioactive materials in a clinical setting, research setting, or both by checking the appropriate box.
8. For radiation-producing machines, check all that apply from the list provided, such as Fixed X-Ray Unit and Portable X-Ray Fluoroscopy.
9. Respond to whether you will be present in the exam room during procedures by checking 'Yes' or 'No.'
10. If you indicated you will perform fluoroscopy once a week, confirm this as well, along with selecting the protective devices you will regularly use.
11. If applicable, provide details about any radioactive material you will be working with, including radionuclides and the maximum radioactivity used in the experiment.
12. Detail your past exposure by listing any employers for whom you wore a radiation dosimeter, along with the period each was monitored.
13. Sign and date the radiation exposure history release statement to authorize the sharing of your exposure history with the Office of Medical Physics/Radiation Protection.
14. Lastly, review the form for completeness and accuracy before saving your changes, downloading, printing, or sharing the form as needed.

Complete your Dosimetry Request online today to ensure proper monitoring and safety.