Densitometer Inspection

• Crew

• Source / Customer / Well Number

• Unit Number

• Conducted on

  Date

• Inspected by

• Location
  Address

• Unit Number

• Source Serial Number

• Source Model Number

• LB 7440

  LB 8010

1.0 Source Condition

• 1.1 Is the source shielding in good condition (no breach, cracks, etc.)?

  Yes

  No

  N/A

• Add media

  Media

• 1.2 Are the source information plates legible?

  Yes

  No

  N/A

• Add media

  Media

• 1.3 Are placards, tags and labels legible?

  Yes

  No

  N/A

• Add media

  Media

• 1.4 Does the shutter work properly and in good condition?

  Yes

  No

  N/A

• Add media

  Media

2.0 Security

• 2.1 Does the source have a secondary cable and lock?

  Yes

  No

  N/A

• Add media

  Media

• 2.2 Does the source have a primary lock for the shutter?

  Yes

  No

  N/A

• Add media

  Media

• 2.3 Are only authorized personnel allowed access?

  Yes

  No

  N/A

3.0 Source Documents

• 3.1 Is the Nominal Source Data sheet present?

  Yes

  No

  N/A

• 3.2 Is the Bill of Lading present?

  Yes

  No

  N/A

• 3.3 Is the Bill of Lading correct (unit number, source number)?

  Yes

  No

  N/A

• 3.4 Is the current device survey present? If so, what is the date?

  Yes

  No

  N/A

• Select date

  Date

• 3.5 Is the current leak test present (less than three years)? If so, what is the date?

  Yes

  No

  N/A

• Select date

  Date

• Inspector

• Add signature

  Sign