Research Safety

Required Monthly Radiological Forms

Use this form to submit documents to the office of Radiation Safety.

You should keep a printed copy of the e-mail confirmation page of this form as documentation of your submission of the requested forms.

Radiological Forms
Please select the form you wish to complete.
(License) Number
Year *
Month *

By completing this form, I affirm and certify that all the information and answers to questions on the documents or monthly survey herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for termination of my radioactive permit, whenever discovered.

First Name of You the submitter
Last Name of You the submitter
Form uploads are not currently available, so please email your file to
Please use the link below to download the Monthly Radiological Survey Form.
In the email Subject line put the following information: example (Smith = PI/AU) "Smith May 2021 Monthly Radiological Survey Form". Please email your completed form to
I understand that it is the responsibility of my laboratory to send in the Monthly Survey each month via email to the Radiation Safety office. I understand that hitting submit below on this form will not fullfil this requierment.