Form RSO1B

Application for Non-Human Use of Radioactive Material - Training, Experience, Laboratory Staff, and Equipment Addenda

Download the RS-01B Word document form

Instructions for Completing the form

Please return the completed Form RS-01B to: Radiation Safety Division CYF G102,
Phone: 500-5840

Section 7: Training in the safe use of radiation
All pertinent training in Parts A-F should be completed by the Applicant with the name indicated.   Please list the university or college where the radiation safety training was received. Also note the duration of the training and whether it was on-the-job or formal classroom training.

Section 8: Laboratory/clinical experience using radiation sources
List prior experience utilizing the requested radionuclides, activities, and protocols described on the RS-01A application (e.g. 32 P, 0.250 mCi, sequencing, 2 years, Texas A&M Univ.).

If an applicant has no direct experience with the protocol or radionuclide, another Authorized User may submit a Memorandum of Supervision stating that the proposed protocol will be performed under their direction until the applicant becomes proficient with that technique.

Section 9: Laboratory personnel using radiation sources
List all laboratory staff working with radiation sources. Laboratory personnel working with radiation must complete the RS-02 (Training and Experience) and RS-03 (Previous Exposure History) forms which are available from the Radiation Safety Division.

All persons working with radiation sources must be informed of the specific hazards of their work. They should initial the RS-01B indicating that they have been informed by the applicant of the potential radiation hazards present in the laboratory.

Section 10: Radiation detection instrumentation
List any portable survey instruments used by or available to the laboratory (example. Ludlum Model 3, SN: 12345). Also, list any analytical counting equipment used by or available to the laboratory (example:   Liquid Scintillation Counter, Packard Tri-Carb Model 4430). Also include the last date of calibration for instruments and counting equipment.

Section 11: Certification
Sign and date on the appropriate line indicating that all information on the application is true to the best of your knowledge and that you intend to comply with the authorization conditions and restrictions imposed by the Radiation Safety Committee at the University of Texas Health Science Center at Houston.