Radiation Safety Forms

updated June 8, 2011

[Scroll down for X-ray or laser related forms]

Radioisotope / Radioactive materials:

Tag- Out for non-functioning meters (November 4, 2008) (doc)

Radioisotope Permit Application Form - RSP-911 -November 5, 2008  (word doc)

Regulatory Exemption Quantities, ALIs and Basic/Intermediate Limits  RSP-922 - November 5, 2008  (pdf)

Personnel Registration and Consent Form (PRCF)- October 27, 2006 (pdf)

Open Source Radioisotope Workshop Registration form (includes PRCF)

Workplace Hazard Information Placard (WHIP sign) 

RSP-490 Compliance Checklist - Open Source Permit (pdf)

RSP-590 Compliance Checklist - Sealed Source Permit (pdf)

CPS Design Standard for renovations or new construction

Radioisotope Purchase Form (updated December 2006)

Detailed procedure for Ordering Radioactive Material from Perkin Elmer

Radioisotope Permit Decommissioning form (pdf)

Weekly Contamination Monitoring Form (pdf)

Contamination limits, action levels and reporting levels (pdf)

Log Sheet (pdf)

Waste disposal fax form for Fort Garry campus (pdf)

Smoke detectors disposal form (pdf)

X-ray Equipment:

All X-ray equipment in Manitoba must be registered with Radiation Protection Services, Cancer Care Manitoba before it can be operated: Department of Health: Registration of X-Ray Equipment Form  

RSP-915 Internal X-ray Permit application

RSP-916 Personnel Registration and Consent Form - X-ray

RSP- 690 Compliance Checklist - Research X-ray Equipment

X-ray Area / Room Warning sign  - Each entrance to a room where a X-ray Equipment is used must have an X-ray area/ room warning sign in addition to any Workplace Hazard Information Placard WHIP sign.  To get your individualized X-ray  Warning sign (free of charge):

1. Fill in the contact details for your X-ray room using the X-ray Area/Room Warning sign template (Word doc)
2. Email the form to EHSO together with the location and number of door/entrances to the X-ray room to radsafe@umanitoba.ca.
3. EHSO will print (in color) laminate and post on each door to any University location where a X-ray is used.

Lasers:

University Laser Inventory form - print, complete and fax to 789-3906 to register your laser equipment with EHSO.

Laser Emergency Response - Treatment Protocol (pdf) - PLEASE POST in all Laser Facilities with open beam Class 3B or Class 4 Lasers

Laser Area / Room Warning sign:  Each entrance to a laser room is where an OPEN BEAM Class 3B or 4 Laser is used must have a laser area/ room warning sign:

1. Fill in the details for your laser in the Class 3B template or Class 4 template
2. Email the form to EHSO together with the location and number of door/entrances to the laser room to radsafe@umanitoba.ca.
3. EHSO will provide and place a red frame and a color print-out using your submitted template on each door to any University location where a Class 3B or 4 laser is used.