PWS Attachment 12 RFP 75N98020R00014.docx
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NIH 88-7 (Rev. 6/2019) RADIATION SAFETY PROCEDURES
| ROOM NUMBER |
| NURSING UNIT |
| ISOTOPE |
| ACTIVITY |
_____________mCi
TYPE OF DECAY
αlpha βeta (γ)gamma
| HALF LIFE |
| DATE |
| SPECIAL REQUIREMENTS |
| MATERIALS TO BE MONITORED |
| MONITORING |
| PERSONNEL CLOTHING |
| FOOD SERVICE |
| ITEMS |
Dosimetry:
· Whole body badge Contamination Meter:
· Pancake probe
· ZnS probe
· Non-absorbent booties
· Rubber/ Nitrile gloves
· Non-absorbent gown
· Regular tray
· Disposable tray
· Eye glasses
· Cellphone
· Contact Lenses
· Dentures
· Other______
INSTRUCTIONS FOR:
VISITORS
HOUSEKEEPING
LABORATORY SPECIMENS
Radioactive labels required
LAUNDRY
Hold for radioactive waste service
| HEALTH PHYSICIST (PRINT NAME) |
| SIGNATURE: |
WORK #: 301-496-5774
HOME #:
CELL #:
TIME LIMITS FOR PATIENT CARE PERSONNEL:
BEDSIDE: ___________Hours/Day 1 METER: ___________Hours/Day DOORWAY: __________Hours/Day IN AN EMERGENCY, THE TIME LIMIT IS:______Hours/Person STATUS of adjacent room: Restricted________Unrestricted_________
EMERGENCY SPILL: DIAL 911 AND ASK FOR RADIATION SAFETY ASSISTANCE!!
PWS Attachment 12 INITIAL AND OCCUPIED POSTING OF RADIATION THERAPY ROOM 5NW AREA RADIATION EXPOSURE DATA (Exposure rates measured in mRem/hour)
SURVEY METER
| SERIAL NUMBER |
| CALIBRATION DATE |
PATIENT NAME
5NWShareDrive\6-2019\p.b.
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