Title Page
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Client / Site
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Location
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Conducted on
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Prepared by
GENERAL NFORMATION
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Authorized Building & Room
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Radionuclides Used & Maximum Activity On-hand:
POSTING & LABELING
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Use & storage room/areas
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Source vials & storage area
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Waste containers
RADIOACTIVE WASTE MANAGEMENT
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Sewer disposal prohibited
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"Mixed" wastes properly identified
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Adequate waste storage location
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Wastes properly segregated
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Waste containers not overfilled
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Secondary containment for liquids
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Containers properly labeled
SECURITY OF LICENSED MATERIALS
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Stock vials secured
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Waste storage areas secured
LABORATORY
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Material use areas approved
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Plastic-backed absorbent paper utilized
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Fume hood adequate airflow
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Airflow checked quarterly
PERSONNEL PROTECTION
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Use of gloves
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Use of lab coats
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Use of shielding, if required
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Eating, drinking, food/utensil storage prohibited
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Mouth pipetting prohibited
PERSONNEL MONITORING
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Whole body badges
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Ring badges & fetal monitors
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Proper badge use & storage
RECORDS
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Copy of approval to use radioisotopes
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Receipt & inventory records
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Disposal records
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Decay-in-storage records
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Survey records
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Leak test records
TRAINING
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Personnel trained
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Training up to date
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Laboratory orientation provided
SURVEYS
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Adequate survey frequency
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Appropriate instrumentation utilized
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Proper interpretation & reporting of results
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Meter equipped with operational check source
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Surveys performed after each use
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Survey meter available & operational
RECOMMENDATIONS
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Enter recommendations here
COMPLETION
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Full Name and Signature of Inspector
