In-Laboratory Contamination Survey

Principal Investigator: Lab Location: Phone #:

Approved Radioisotopes to Use:

INSTRUCTIONS (see Radiation Safety Manual section 3.17 & 3.18.6 for details) : 1. If you “handle” more than 0.5 milliCuries of radionuclide(s), perform smears in your laboratory. 2. Also survey for contamination with appropriate instrument. 3. Area must be cleaned promptly and properly if contamination is indicated. 4. Re-wipe contaminated area to ensure that the removable contamination has been cleaned. 5. Complete the form below and attach analysis print out. 6. File the form in the Radiation Safety Manual binder for future review at semi-annual inspections.

Surveyed Radionuclide(s) Contamination Survey Corrective Date Signature By Used Location* Reading** Action

* Use existing laboratory diagram(s) provided by the Radiation Safety Office. If necessary, draw additional diagram in the space below. ** 3H and 14C do not require a survey measurement.