Form for Transfer of Radioactive Materials
Clarkson University
Please use this form to request for transfer of radioactive materials that are registered at Clarkson
University. The transfer may be from one location to another, or to an off-campus location. Please
fill out the appropriate information and send the form to the address below.
Name ____________________________________________________date________________
Type of material (activity, serial #, chemical form)___________________________________
Prior approved location (building and room)_______________________________________
New location (building and room)_________________________________________________
Comments_____________________________________________________________________
Please send the completed form to:
Craig Woodworth
Radiation safety Officer
Box 5805
Clarkson University
Tel: 315-268-2391
E-mail: woodworth@clarkson.edu