Radioactive Material Order Notification Form
Program Areas

Biological Safety

Campus Safety

Education and Training

Environmental Health

Fire Prevention

Hazardous Waste Management

Industrial Hygiene

Radiation Protection

 

 

  

1. AUTHORIZED USER INFORMATION*
First Name Last Name
Room Number Phone Number
Department Other Department:
 
Building Other Building:
Email Address
*Note to Authorized Users: This electronic form is to be used to notifiy the Environmental Health & Safety, Radiation Safety Program that you have placed an order for radioactive material (RAM). You must still place your order with the vendor.

2. RADIOACTIVE MATERIAL INFORMATION

Isotope: 

Other Isotope:  

Activity mCi: 

   

Chemical/Physical Form: 

Other:

Catalog Number: 

PO Number:

Price: 

   

Date Ordered: 

Expected Delivery Date:

Comments