26-weekly Waste Management Facility Radiological Survey.pub

Building Suffix Floor Wing Room Rooms Linked on the Survey Survey Date (mm/dd/yy)

Authorized User: Last Name, First Name RSB User # Phone # Surveyor: Last Name, First Name RSB User # Phone #

Check here if radionuclides were not used this weekly in all modules represented on this form. [ ] Surveyor’s Signature:

Smears Results In DPM / 100cm2; Printout Must Be Attached Location Beta Gamma Alpha

Weekly Laboratory Contamination Survey National Institutes of Health Radiation Branch (Bldg. 21/116) RSB 496-5774 or FAX 496-3544 Send original to RSB, and retain copy in laboratory records for three (3) years Comments:

Y N N/A Requirement Y N N/A Requirement

Room / Area Posting

Survey Instruments Calibrated

Adequate Personnel Monitoring

Survey Records Present

Adequate Radionuclide Storage

Security of Licensed Material

Routine Use of PPE

Contamination Limits Acceptable

Prohibition on Eating & Drinking

Fume Hood(s) in Calibration

Radiation Levels

Appropriate Waste Management

Survey Instruments Operational

Limit dpm/100cm2 Analyte

ROI

Action Level % Eff CT(m)

MDA

dpm/100cm2 Gross g

Gross b

Gross a

ATTACHMENT 26

Liquid Scintillation Counter [ x ] Gamma Counter [ ] Make: Beckman Coulter Make:

Model: LS 6000LL Model:

Ser #: 7066161 Ser #:

Type of Counter Used to Analyze Smears Make:

Make:

Model/Probe Type:

2/Pancake GM Model/Probe Type:

Ser #:

Ser #:

Cal Date:

Cal Date:

Type of Meters Used Bkgd.

Bkgd.

See attached map