Research Safety

Required Monthly Radiological Forms

Use this form to submit documents to the office of Radiation Safety.

You should keep a printed copy of the e-mail confirmation page of this form as documentation of your submission of the requested forms.

Radiological Forms

Radiation Form Selection *

Please select the form you wish to complete.

First Name of Authorized User (PI) *

Last Name of Authorized User (PI) *

Radioactive Materials Permit # *

(License) Number

Building & Room Number(s) *

Lab Contact Phone Number *

PI Email Address

Year *

2022

2023

2024

Month *

By completing this form, I affirm and certify that all the information and answers to questions on the documents or monthly survey herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for termination of my radioactive permit, whenever discovered.

First Name *

First Name of You the submitter

Last Name *

Last Name of You the submitter

Section Buttons

Form uploads are not currently available, so please email your file to radiation-safety@uga.edu

Alternate Email contact

Date Submitted *

Comments

CAPTCHA

Please use the link below to download the Monthly Radiological Survey Form. https://research.uga.edu/safety/wp-content/uploads/sites/56/2015/01/9_radiation_survey_form.doc

In the email Subject line put the following information: example (Smith = PI/AU) "Smith May 2021 Monthly Radiological Survey Form". Please email your completed form to radiation-safety@uga.edu

I understand that it is the responsibility of my laboratory to send in the Monthly Survey each month via email to the Radiation Safety office. I understand that hitting submit below on this form will not fullfil this requierment.

I understand, and will email my form.

I dont understand.

If you are human, leave this field blank.

Contact

Radiation Safety

Chemical & Laboratory Safety