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Environmental Health & Safety

 

Personnel Dosimetry Application

Marked fields are required.

Personnel Information

First Name: Last Name: Middle Initial/Name:
 
Employee ID: Date of Birth (mm/dd/yyyy):
 
(Your FSU employee ID number is a nine-digit number located on your paycheck as viewed in OMNI. A FAMU employee ID number is also acceptable. If you are an unpaid student worker, please use your FSU security number. If you are a visitor, leave blank.)
 
Status: Gender:
Male Female
 
FSU Email Address: Phone Number:
Alternate Email Address:
 
X-Ray Information

Will you be working with X-Ray? Yes No
 
What X-Ray machine will you be using? X-Ray Building: X-Ray Room #:
 
EH&S Radiation Safety Department Online X-Ray Training Completed? Yes No
**Must be completed before research begins**
https://safety.fsu.edu/sections/training/xray/
Radioactive Materials (RAM) Information

Will you be working with radioactive materials (RAM)? Yes No
 
Building: Room #:
 
If yes to radioactive material usage: An onsite training through EH&S Radiation Safety Department is required- email: izbyrowska@fsu.edu or aa23cm@fsu.edu to schedule.
**Must be completed before research begins**
Department Staff Info

Principal Investigator: Phone Number:
 
Supervisor/Lab Manager: Phone Number:
 

Instructions:

  • Wear whole-body dosimetry with the window towards potential radiation sources, and between your waist and neck. (If you are assigned a ring TLD and you wear disposable gloves, wear it under your glove with the element towards the radiation source).
  • Always wear your assigned dosimetry as required while working in designated radiation areas or handling radioactive materials.
  • Never wear dosimetry assigned to another user and do not allow others to wear your assigned dosimetry.
  • When not wearing the dosimetry, leave it in a non-radiation area, preferably in designated locations.
  • Avoid taking dosimetry home. If you do, protect it from diagnostic X-rays, excessive heat, etc. If such exposure occurs, or if it is lost, notify the Radiation Safety Office as soon as possible.
  • Obey all safety rules specified in the FSU Radiation Safety Manual and any additional instructions given by your PI or Radiation Safety Office personnel, when working in radiation areas or handling radioactive materials.
  • If using radioactive materials, please contact the Radiation Safety Office in order to ensure that the training and experience section of your PI's Proposal has been completed authorizing your activities.

I have read and understand the above instructions and request that appropriate dosimetry be assigned to me.