Get Radiation Use Application (pdf) - California State Polytechnic ... - Csupomona

Completing the Radiation Use Application is an important step for anyone seeking authorization to use radioactive materials or radiation-generating machines at California State Polytechnic University, Pomona. This guide provides detailed, step-by-step instructions to assist you in accurately filling out the form online.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the application and open it in your preferred PDF editor.
2. Enter the location where the radiation use will occur, filling in the department and the building/room number as required.
3. Provide your name, employee/Bronco ID number, extension, and date on the designated lines.
4. Complete the home address section with accurate details to maintain contact information.
5. Indicate whether the application is for instructional or research purposes, providing a brief description in the corresponding field.
6. List the radioactive materials or radiation-generating machines involved, including the nuclide or manufacturer, chemical form, physical form, maximum voltage, maximum current, and total activity or rem/hr ft.
7. Detailed descriptions of the procedures, activities, and operations involving radiation should be documented to explain how they will be conducted at the university.
8. Fill out the training section, indicating whether you are a high school graduate and providing information about your college or university education, including name, address, and contact details.
9. List your experience with radioactivity, starting with the most recent positions, including dates, titles, duties, employers, and contact information.
10. Describe the equipment, laboratory facilities, and procedures you will implement to ensure radiation control, ensuring maximum exposure does not exceed 2 mrem/hr.
11. Provide details of your radiation disposal procedures, referencing the Radiation Safety Manual for compliance.
12. List all personnel involved in the project, including their names, ages, employee/Bronco ID numbers, project duration, and personal radiation monitoring methods.
13. Sign and date the certification provided at the end of the application to verify the accuracy of the submitted information.
14. Once you have completed all sections, save your changes, then download, print, or share the form as needed.

For a smooth application process, start filling out your application online today.