Proposed Scheme of Work with UNSEALED RADIONUCLIDES

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PROPOSER SECTION

First Name:	Click to add.	Surname:	Click to add.
Institute/Unit:	Click to add.	Location of work:	Click to add.
Name of RPS:	Click to add.	Email:	Click to add.
Name of ARS:	Click to add.	Name of PI:	Click to add.

DETAILS OF PROPOSED EXPERIMENT/PROCEDURE (Click on table to add new row)

Nuclide	Max. Activity Handled	Max. Activity Concentration	Compound
Choose/add a nuclide.	Click to add.	Unit.	Click to add.	Unit.	Click to add.

Brief outline of proposed use: Click to add.

Will there be radioactivity in a particulate, aerosol or gaseous form? Choose an item.

Why do you need to use radioactivity? Click to add.

Do any of the University Generic Radiation Risk Assessments apply to this work? (http://www.ed.ac.uk/health-safety/radiation-protection/tools-forms/tools)

YES ☐	NO ☐	If YES, what number is it?	Please specify.

Have you read the relevant Local Rules? YES ☐ New Local Rules Required ☐

What categories of waste will arise? (tick all that apply)

Solid combustible	☐	Liquid to drains	☐	Non-aqueous miscible liquid	☐
Airborne	☐	None	☐	Other	☐	If other, please specify.

Is there an existing estimate of the waste fractions for this experiment?

YES ☐	NO ☐	N/A ☐	If YES please specify the existing scheme	Please specify.

All of the following Codes of Practice (http://www.ed.ac.uk/health-safety/radiation-protection/policy-guidance/codes-of-practice) should be reviewed before proceeding with any work:

RP CoP003	Contamination Monitoring Procedures in Research Laboratories
RP CoP004	Protocol for Determining the Relative Fractions of Waste Activity Arising from Experimental Work with Unsealed Radioactive Material
RP CoP005	Accounting for Radioactive Sources
RP CoP006	Working with Unsealed Radioactive Materials
RP CoP009	Waste Disposal
RP CoP010	Accounting Procedures for Unsealed Radioactive Material
RP CoP011	Controlled and Supervised Areas
RP CoP012	The University’s Organisation and Arrangements for Compliance with the Conditions of its Radioactive Substances Act Certificates of Registration and Authorisation
RP CoP017	Transport of Radioactive Materials

PROPOSER DECLARATION

I declare that I will seek instruction from my RPS on the methods of working, monitoring and keeping records	☐
I declare the information above is accurate and the activities stated will not be exceeded	☐
I declare that I will read all Codes of Practice recommended by the University RPU	☐
I understand that any changes in the details of the scheme will require further authorisation	☐

Signed:	Click to add.	Role:	Click to add.
Date:	Click to add date.

RADIATION PROTECTION SUPERVISOR USE ONLY

Tick the relevant box if the activity limits of the existing Permits would be exceeded by this proposal.

Holdings ☐	Disposals ☐	Not Applicable ☐

I certify that the above proposal is satisfactory to the unit ☐

I certify that the proposer has satisfied the basic training requirements of the University ☐

Signed:	Click to add.	Position:	Choose an item.
Date:	Click to add date.

RADIATION PROTECTION UNIT USE ONLY

Has been approved without further conditions	☐
Has been approved with additional conditions (see below)	☐
Has NOT been approved	☐

This scheme:

The following personal monitoring is required:

Whole body dosimeter	☐	Extremity dosimeter	☐
Urine monitoring	☐	Thyroid monitoring	☐
Eye dosimeter	☐	Other	☐	Please specify.

No personal monitoring is required ☐

Signed:	Click to add.	Choose an item.
Date:	Click to add date.

Additional Conditions:
Click or tap here to enter text.