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 Forms

(fax completed forms to EHS at 2-1600 or 215-707-1600)
  		•
  • Radioactive Material
      -

    Register as radiation worker

    PLEASE READ: A complete Radiation Worker Registration form requires TWO signatures: one for the applicant and one for the person that will be supervising the applicant's radioactive material use.  Also, the area of the form titled "Experience" must have some form of positive reporting: if the applicant has never worn a radiation badge (dosimeter) before please write NONE or NO.  If they have been badged prior to coming to Temple, please indicate the name, location and dates of employment.  Do not leave this section blank.  Please do not submit the form until all the above information has been provided.  Thank you.

  • Get or change authorization to use radioactive materials
      a) New Authorization
      b) Change Possession Limit
      c) Change Chemical form or Procedure
       

  • Order radioactive material

    Perkin Elmer Discounted RAM Price List for Temple University

    Attention Radioactive Material Users re: Ordering of Radioactive Materials

    Environmental Health and Radiation Safety is no longer able to obtain Emergency Purchase Order numbers for users of radioactive material.   From this point forward, Principal Investigators and their Departments should obtain Master Purchase Orders for each company they may order material from.  If a radioactive material purchase request comes into EHRS without a Purchase Order number we will return it without ordering.  Please contact the Purchasing Department for more information regarding Master Purchase Orders.

    The following are the shipping costs when radioactive materials are ordered from
    PerkinElmer:

    Friday shipping for Monday arrival -- $4
    Monday shipping for Tuesday arrival -- $4

    Shipping for all other days will cost $24.
       
  • Chemical
      - Chemical waste pickup requests
      - Blank Hazardous Chemical Inventory Excel Spreadsheet
      - Request to Test Unknown Chemical Form
  • Biological
      -

    Assurance on Hazardous Procedures

    NOTE: Form has been updated as of 7/16/07.  Please use this version of the form from this point forward.
      - Biological Registration Form (BRF)
      - CDC Importation Permits for Ethiologic Agents
      - CDC Application for Permit to Import or Transport Etiologic Agents, Hosts, or Vectors of Human Disease
      - Safer Sharps Device Evaluation Form
  • Special Biological Agents and Toxins
      - SBA-3:Special Biological Agent Authorized Individuals List
      - SBA-4: Select Biological Agent and Toxin Entry and Exit Log
      - SBA-7: Application for Select Biological Agents Procurement
      - Select Biological Agents Inspection Survey
      -

    Principal Investigator Registration for Select Agents

  • MRC Application | What is the MRC?  |  What is the RDRC?
      - Application for Non-Routine Administration of Radionuclides or Radiation to Humans
       
  		• Word format  |  PDF format
  • Lab Safety
      - Certification of Laboratory Vacancy
      - Decontamination of Instruments
      -

    Weekly Eyewash Check Sheet
      -

    Fume Hood Survey Form

      -

    Biological Safety Cabinet Survey Form

      -

    Laboratory Safety Program Self Audit (NOTE: This form and process is optional.  It is NOT required.)
      - PPE Hazardous Assessment Certification Form (in RTF format -- can be completed on your computer)
  • Shipping of Dangerous Goods
      -

    Email Notification of Dangerous Goods Shipment to EHRS
    New Item  - Emergency Response Guide for Dry Ice
    New Item - Emergency Response Guide for Biological Materials


     
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