Principal Investigator/ Course Coordinator:
Project Title:
OLS Tracking #:

Project Review Form

Addendum D – Radioactive Material

Addendum D must be completed for all projects involving sealed or open sources of radioactive material.

Part 1 – Radiation user information:

  1. Check all that apply:

The applicant is an Approved User of radiation producing instruments at Mason.
The applicant is not an Approved User and has included a Radiation User Authorization form for review.
The applicant is not the Approved User for this project.
The Approved User for this project is:
All laboratory personnel involved in this project other than the applicant are Supervised
Users or Approved Users or Student Users.
Radiation User Authorization forms for laboratory personnel other than the applicant have been submitted for review.
B. List all laboratory personnel who will use radioactive materials as part of this project. Provide most recent training dates (month/year).
Name / OLS Training
(user/ refresher) / Laboratory specific training
from Approved User
For Instructional courses, a roster of Student Users will be maintained by the course instructor.
C. Describe the content of laboratory specific training (in addition to OLS training) that will be provided to Supervised Users or Student Users by the Approved User.
Training documents are attached.

Part 2 – Radioactive materials and procedures:

D. List the radionuclides to be used in this project:
Radionuclide and chemical form / Max. quantity to
be purchased at one time (mCi) / Max. quantity to
have in inventory at any one time (mCi) / Est. quantity to be used within 3 years of project start / Physical form (liquid, gas, powder, sealed source)
  1. Yes No Radioactive material is to be used with animals and
The project has been approved by IACUC.
IACUC Protocol # :
This protocol has been submitted to IACUC for review.
If yes, provide the following information:
Animal species / Radionuclide administered / Amt (mCi) administered per animal / Bldg/Rm where radioactive animals will be housed / How long will animals contain radioactivity before being sacrificed?
Indicate the anticipated fraction of radioactivity for each of the following:
Excrement / Exhaled air / Carcass
  1. List and describe procedures to be performed that will involve radioactive material. Experimental protocols may be attached.

See attached experimental protocols.
G. Radioactive Waste:
A radiation disposal sink has already been designated in the laboratory where radioactive material experiments are to be performed.
Mixed biological waste will be generated from this project. Explain procedures in placeto decontaminate, treat, and handle mixed biological waste.
Mixed chemical waste will be generated from this project. Indicate chemicalcomposition of this waste (i.e.: phenol chloroform, flammable LSC cocktail, etc.)
Estimate annual quantities (mCi) for each of the following:
Solid Waste (mCi) / Bulk Aqueous Waste (mCi) / Bulk Organic Waste (mCi) / Mixed Biological Waste (mCi) / Mixed Chemical Waste (mCi) / Animal Waste (mCi) / Flammable LSC (mCi) / Aqueous LSC (mCi)

Part 3 – Facilities and safety practices:

H.List all locations where radioactive material will be used and stored.
  1. List precautions that will be taken to minimize occupational exposure to radioactive materials. Include personal protective equipment, shielding, use of fume hoods, etc. Be specific.

  1. List type of survey instruments that will be utilized to detect radioactive material (portable meters, liquid scintillation counters, etc.). Include serial # for these instruments.

Instrument / Serial Number
  1. List precautions that will be taken to ensure that unauthorized personnel do not gain access to radioactive material (stockvials, experimental sources, radioactive waste etc.).

  1. A dark room/ X-o-Mat will be required in this project.

1

Office of Laboratory Safety

Project Review Form - Addendum D

5/2006