• Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

If Radioactive Materials (RAM) are being received, stored, administered, or disposed of in this department:

  • What radioisotopes are being used?

  • Are all rooms containing RAM secured when unoccupied

  • Are all rooms containing RAM appropriately identified with signage and all required postings?

  • Is an appropriate, operating, and calibrated radiation survey meter available to monitor for contamination?

  • Are dosimeters being worn as required?

  • Are RAM areas free of eating, drinking, smoking, and application of cosmetics?

  • Can staff explain the procedures to follow in the event of an accidental spill of RAM?

  • Can staff describe where they can access TDSHS regulations?

  • Is the Radiation Safety Manual readily available?

If Radiation Producing Machines (x-ray machines) are used in this department:

  • What are the serial numbers of a representative sample of the machines?

  • Are all rooms containing x-ray machines appropriately identified with signage?

  • Are lead protective devices available and being used?

  • Have lead protective devices been inspected in the preceding 12-month period?

  • Are dosimeters being worn as required?

  • Are control panels marked with appropriate warnings?

  • If manual techniques are used, are they documented and readily available?

  • Has the annual physics survey and inventory of the x-ray producing device been performed within the preceding 12-month period?

  • Have all operators of x-ray machines reviewed the operating and safety procedures? Documentation available? (Required annually)

  • Is the Radiation Safety Manual readily available?

If Class 3B or Class 4 lasers are being used in the department:

  • What are the make, models & serial numbers of a representative sample of the lasers?

  • Are all rooms containing lasers appropriately identified with signage (warning lights outside room is required for Class 4 lasers)?

  • Is laser equipment properly labeled with ANSI-compliant labels?

  • Has the laser been checked and inspected by CES?

  • Is appropriate laser protective eyewear available for the laser being used?

  • Is the key removed from the laser and stored separately when not in use?

  • Is the Laser Safety Manual readily available?

If Magnetic Resonance Imaging (MRI) machines are used in the department?

  • Are the required MRI zone signs posted?

  • Can staff describe the procedure to follow if someone were to be pinned to the magnet?

  • Can staff describe the screening of patients and equipment that will enter the magnet room?

  • Is the MRI Safety Manual readily available?

Additional Safety Observations

  • Enter any additional safety observations/deficiencies:

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