Information

  • 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:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.