WKU Environmental Health & Safety-Radiation Safety Training Registration Form

Radiation Safety Training Request Form

Radiation Safety Training is required prior to use of radiation sources. Training should also be received by ancillary employees prior to beginning work. Choose the type of radiation safety training you are requesting and then complete the rest of the form.

Definitions:
Responsible Investigators - Licensed radioactive material users
Authorized Users - Radioactive material users supervised by Responsible Investigators
Ancillary Personnel - Clerical, janitorial, security, maintenance, office, etc. positions that may be required to work in the vicinity of radioactive materials but are not users of radioactive materials
Radiation Producing Machine Users - Users of equipment that produces radiation electronically, e.g., x-ray diffraction, x-ray fluorescence, accelerators, etc.

Radiation Safety Training Session: (Select all that apply)	Responsible Investigator Authorized (Supervised) User Ancillary Employee Radiation Producing Machine User

Specific Use: (Select all that apply)	Open Source Portable Gauge Sealed Source Van de Graaff XRD XRF

Additional Notes: (50 characters max.)

Attendee(s) Department :
Attendee(s) Supervisor/Manager :

Submitter's Email Address :
Today's Date :

Employee(s) Needing Training

Note: The completion of the Radiation Safety Training described above does not, by itself, authorize you to use radioactive materials. Contact the Radiation Safety Officer for instructions on how to obtain approval for radioactive materials use.

Form created: November 4, 2005
Form updated: September 23, 2008