Radiation Safety Environmental Tours

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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

• What radioisotopes are being used?

  P-32, S-35

  C-14, H-3

  F-18

  Tc-99m

  other

• Are all rooms containing RAM secured when unoccupied

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are dosimeters being worn as required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Can staff describe where they can access TDSHS regulations?

  Yes

  No

  N/A

• Is the Radiation Safety Manual readily available?

  Yes

  No

  N/A

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?

  Yes

  No

  N/A

• Are lead protective devices available and being used?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are dosimeters being worn as required?

  Yes

  No

  N/A

• Are control panels marked with appropriate warnings?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the Radiation Safety Manual readily available?

  Yes

  No

  N/A

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)?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the laser been checked and inspected by CES?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the Laser Safety Manual readily available?

  Yes

  No

  N/A

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

• Are the required MRI zone signs posted?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the MRI Safety Manual readily available?

  Yes

  No

  N/A

Additional Safety Observations

• Enter any additional safety observations/deficiencies: