Radiation Safety

Annual inventory report

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UBC Radiation Safety

Annual Inventory Report Form

for report year 2011

Welcome to the UBC Radiation Safety Inventory Report Form intended for UBC licensed radioisotope users only.

Instructions:

Fill in ALL of the fields for EACH of the radioisotopes in your possession. ALL radioisotopes must now be accounted for on your permit. Exemption Limits are no longer in effect at UBC. Please refer to your current permit, and any associated amendments, for this information. If you are still uncertain please contact the Radiation Safety Office at (604) 822-7052.

Please use your CURRENT LICENSE NUMBER and LAST NAME of PERMIT HOLDER. If you have more than one radioisotope on your license, fill out the form for EACH radioisotope, even if you have not purchased, used or disposed of any radioisotope in 2011 (enter '0' where appropriate).

Example: If you have H-3, C-14 and P-32 on your inventory, you will need to fill out the form three times, once for each isotope. When you are finished, proceed to the bottom of the page to view all entered records for License #. Please print this summary and retain with your radioisotope records.

If you shared a purchase of material you are responsible for the purchase (acquisition) if it was made under your permit through the UBC Online Purchasing System. If you transferred any purchased (acquired) material to another licence holder at UBC, it is the other license holder's responsibility to report this as "acquired" activity. Please ensure that the license holder to whom you transferred the material to reports the activity on their annual inventory.

Note: All transfers need to first be reported to the Radiation Safety Office for approval.

ALL AMOUNTS MUST BE ENTERED IN UNITS OF MBq

Last Name of Permit Holder:

Your Permit Number (just the middle 4 digits):

Date of report:

5/16/2012

Name of Person Submitting Report:

E-mail:

Phone:

List of Authorized Users (list the names of the authorized users with their certification date in brackets):

Isotope (eg. P-32, C-14):

Total Activity Carried Over from 2010:

MBq

Total Activity Acquired in 2011 (includes all acquisitions - purchases, transfers from other permit holders, gifts, etc.):

MBq

Total Activity Disposed By Decay (Radioisotopes with short half-lives [<90 days] can be disposed of in this manner. Includes all liquids, combustible waste and non-combustible waste that have been held for decay prior to being disposed of):

MBq

Total Activity Disposed of as Liquid Waste Through Drains (if the liquids were held while the isotope decayed, that activity should be entered in the Total Activity Disposed by Decay box):

MBq

Total Activity Disposed as Combustible Waste (i.e. Pathology waste/animal waste):

MBq

Disposal as Solid Non-Combustible Waste (i.e. Material disposed of as solid waste) - This field does not include activity that has already been entered in the Total Activity Disposed By Decay box. This field is often used for long-lived isotopes like H-3 or C-14:

MBq

Note: Fill in the field in this section ONLY if you transferred isotope to the UBC Radiation Safety Office.
Delivered to Radiation Safety Office for shipment to Chalk River Waste Facility: