[content]

Quick Links
	Fact Sheets
	Forms
	Guides
	Training
	Waste Disposal

CEHS Sections
	Enviro Compliance
	Lab & Haz Waste
		Biological
		Chemical
	Occ Health/Safety
	Radiation Safety
__
CEHS Information
	About CEHS
	Awards
	Feedback
	Links
	News
	Safety Committees
	Search
	Staff Directory

Iodination Waste and Urine Sample Form

Personnel who have been approved by the Radiation Safety Officer to conduct iodinations shall complete the following form upon completion of each iodination procedure. Urine samples from personnel conducting iodinations are required in order for the Radiation Safety Officer to conduct a bioassay to determine the possible uptake of radionuclides during the iodination procedure. Personnel shall produce a urine sample 22-26 hours upon completion of the iodination procedure. Please label the urine sample container with the individual's name and date of urine production.

Please note that the iodination waste activity is not recorded separately for liquid and solid waste. The iodination waste activity is totaled, and the waste is to be left inside the fume hoods of either Life Science III 2016 or 2017 for collection by the staff of Radiological Control.

[FrontPage Save Results Component]

Biographical Information

Name:
Email Address*:
Phone Number:

*: This field is required. This form will not be received by staff if Email Address is not filled in

Iodination Procedure Information

Date of Iodination:
Time of Iodination:
Date of Urine Sample Production:
Time of Urine Sample Production:
Location of Urine Sample:
Total Activity Used in Iodination Procedure (mCi):

Iodination Waste Information

Location of Iodination Waste:
Isotope: I-125
Assay Date:
Total Activity of Iodination Waste (mCi):

Additional Comments: