Personal Survey Form


Permit Holder:  __________________   Building:  ____________   Room# _____
Directions:
  1. Hands and working area should be surveyed after each use of radioactive materials. Wipe tests are required for work with 3H.
  2. Forms should be kept on record, either in laboratory notebook or office file. Notify Radiation Protection Office, immediately of any personal contamination detected.

Date Name Isotope Survey Meter Reading Notes
      Hands and Clothing Work Areas On High or Positive Results
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           

Any concerns or questions contact the Radiation Protection Office: 495-2060.