APPENDIX D
Radioactive Materials Monthly Inventory Form

For the month of __________________

Authorized User_____________ Person Reporting: _________________Phone #___________

Each reporting period, you will receive a printout of your Total Inventory of P.I. report as of the date indicated. Please document the disposition of the radionuclides below. Record the amount of material transferred this month to waste or another user. Include the Ship code from the report. When the vial activity is disposed, enter the date of disposal. The ship code will be removed from the inventory. Keep the Total Inventory of P I printout for your records and send the completed Radioactive Materials Monthly Inventory Form to the Radiation Safety Office, 102 Animal Pathology, 0076 or fax to 323-4752 by The 15th of ______________________

If the Total Inventory of PI printout is correct, indicate here. (Circle) No Change

Method of Disposal
Ship Code Isotope (Optional) Initial Activity Drain Waste Dry Solid Waste Bulk Liquid Liquid Scint. Other (Specify) Transfer Amt. To/From Whom Date*
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     

*Enter date when total activity is in Lab Waste

Radiation Safety Manual | Appendix C | Appendix E

Webmaster J. King
7-23-2002