PWS Attachment 9 RFP 75N98020R00014.pdf

TYPE OF COUNTER USED TO ANALYZE SMEARS: MONTHLY LABORATORY CONTAMINATION SURVEY

Liquid Scintillation Counter [ ] Gamma Counter [ ] LSC or Gamma Counter Property #:

Building Suffix Floor Wing Room Suffix Survey Date (mm/dd/yy) Indicate radionuclides and activities used since last monthly survey: Activity = Total amount used since last monthly survey.

Isotope Activity (in mCi) Isotope Activity (in mCi)

Authorized User: Last Name, First Name DRS User Number Phone Number H-3 P-33 S-35 I-125 C-14 I-131

Surveyor: Last Name, First Name DRS User Number Phone Number P-32 Cr-51

NOTE: All No-Use surveys are to be submitted solely via the AU portal.

SURVEYOR'S SIGNATURE SMEAR RESULTS (in dpm/100cm2)

Fill in radionuclides and indicate quantitative smear results in DPM.

DPM = CPM / COUNTER EFFICIENCY

PRINTOUT MUST BE ATTACHED! DIAGRAM OF LABORATORY: Sketch module(s) and number locations smeared. A minimum of 10 smears must be taken in each module where radionuclides are used, with at least two on the floor. If a module had no radionuclide usage, submit a No-Use survey via the AU portal. Location Nuclide 1 Nuclide 2 Nuclide 3

BKG

REMARKS: Include explanation of actions taken for smears >2,200 dpm/100cm² beta-gamma or >220 dpm/100 cm² alpha. 18

NIH 88-12 8/18

National Institutes of Health, Division of Radiation Safety (Bldg. 21/116) DRS (301) 496-5774 or FAX (301) 496-3544. Send original via email (preferred), fax, or intra-campus mail to DRS, and retain copy in lab records for 3 years. Email: drssurveys@mail.nih.gov

PWS Attachment 9 oandasannl Sticky Note Accepted set by oandasannl oandasannl Sticky Note Marked set by oandasannl oandasannl Typewritten Text oandasannl Typewritten Text oandasannl Typewritten Text For detailed instruction on completing the NIH 88-12 form, go to: https://drs.ors.od.nih.gov/policies/Pages/8812instructions.aspx

INSTRUCTIONS FOR COMPLETING MONTHLY LABORATORY CONTAMINATION SURVEYS

LOCATION: Complete information as requested.

SURVEY DATE: Date the smears were actually taken (not when counted).

AUTH. USER: self explanatory

SURVEYOR: self explanatory

If radionuclides were not used, submit a "No-Use" survey via the AU portal.

SURVEYOR SIGNATURE: Survey should be signed by the person actually performing the survey (AU signature also acceptable).

DIAGRAM: The diagram should represent the room or module listed at the top of the form. A minimum of 10 smears should be taken for each module, two of which must be on the floor.

REMARKS: A remark indicating corrective action is required for any contamination over set limits.

TYPE OF COUNTER: Indicate type of counter used to analyze smears and its NIH Property Number.

RADIONUCLIDES USED: Indicate which radionuclides were used and how much in that month.

SMEAR RESULTS: A copy of the printout MUST be attached, with the data and counting parameters shown. If date is incorrect or cannot be printed, surveyor must write in date and initial it. A quantitative result must be listed for each smear taken in DPM. If counter does not automatically convert results from CPM to DPM, the surveyor must convert all results to DPM. Writing statements such as "<2200", or "< Background" will not be acceptable as results. "See Printout" will be acceptable IF results on printout are clearly shown in DPM. Smears are not required if no radionuclides were used.

Also, it is suggested that a blank (background) smear be added to each smear set.