RADIOACTIVE MATERIAL USE PERMIT APPLICATION
Environmental Health and Safety
HOW TO GET STARTED USING RADIONUCLIDES
Overview
A license to possess and use radioactive materials (RAM) has been issued to UTMB by the Texas
Department of Health. Under the terms of this license, the Radiation Safety committee (RSC) is delegated
the responsibility for authorizing qualified individuals to use radioactive materials.
The Principal Investigator is DIRECTLY responsible for all aspects of radiation safety associated with
his/her possession and use of radioactive materials.
Things to Know
The use of radioactive materials at UTMB requires specific authorization from the UTMB-RSC. Because
the application and authorization process can take several months, Principal Investigators who plan to use
radioactive materials should apply to the RSC well in advance of the anticipated date of use.
Principal Investigators moving to UTMB from other institutions should contact Environmental Health and
Safety prior to arriving at the UTMB campus for information and guidance. One of the RSC’s
requirements is that a letter of recommendation accompany an application and it may be easier to arrange
for this before leaving one’s present institution.
Radiation Safety staff members will assist researchers with the completion of this application.
Investigators wishing to bring radioactive materials to the UTMB campus from their present institution
must contact OEHS (prior to the shipment of radioactive materials) and make arrangements to meet all
legal requirements.
For Further Information:
Contact Environmental Health and Safety/Radiation Safety Program at (409) 772-2279 (mail route F-33)
for additional information and assistance concerning radioactive materials usage.
INSTRUCTIONS FOR COMPLETION OF “APPLICATION FOR RADIOACTIVE MATERIALS
USE PERMIT”
1.
Complete name and campus mailing address of the applicant (s). Please be sure to include
building, room number and telephone number. The Authorized User (s) will be responsible
for the direct supervision and required training for the technical staff that actually performs
studies with the radioactive material. Each Authorized User must be fully qualified by
training and experience to use or supervise the use of each radioactive material for which he is
approved. Please list the Permit Administrator as the first Authorized User. This individual
shall be responsible for ensuring that all appropriate records are kept in accordance with
UTMB Policies for the control of radiation, shall inform the Radiation Safety Committee
when any Authorized user leaves UTMB or ceases using radioactive material, and shall be the
individual to whom correspondence regarding the permit will be addressed. Each Authorized
User should complete Supplement A for Non-Human Use or Supplements B and C for
Human Use. Two or more individuals who use the same location (s) should submit only one
application.
2.
For each radionuclide listed in item 5, list those letters that correspond to those radionuclides
the Authorized User will use.
3.
Self-explanatory. If this is to be an amendment or renewal to the permit, a Supplement A
must be attached for each Authorized User.
4.
List building and room number where radioactive materials will be used and stored.
5.
Describe the radioactive material to be used, including the material’s chemical and/or physical
form, number of millicuries to be kept in your inventory, maximum number of millicuries per
experiment, and the purpose for which the material will be used (in-vitro, in-vivo, or human).
6.
Attach a list of technical staff.
The technical staff is composed of those individuals who use radioactive materials to conduct
research or perform clinical procedures under the direct supervision of an Authorized User.
The technical staff should be named in the application and shall be instructed in the health
protection problems associated with exposure to radiation, precautions to minimize exposure,
emergency procedures, and applicable State and UTMB regulations. (Supplement A does not
have to be submitted for technical staff who are not to be Authorized Users.) The Permit
Administrator must notify the Office of Environmental Health & Safety of any changes in the
technical staff.
7.
Supplement A must be attached for each Authorized User. If human use is involved,
Supplements B and C for each user must be attached.
8.
Instrumentation available (information should be supplied on Supplement D furnished with
the application.) Describe the type of instrumentation and the frequency and method for
calibration of measurement instruments. Survey instruments will be calibrated by the Office
of Environmental Health and Safety semi-annually.
*9.
On the attached form, (Supplement E), provide a diagram of the laboratory in which
radioactive material will be used and stored, with the radioisotope work area identified.
Describe storage facilities, fume hoods, special shielding, sink used for liquid waste disposal
and any other information pertinent to the discussion of the application.
*10.
Attach a copy of your rules for the safe use of radioactive material.
The set of rules prepared should be included in your safety manual or posted prominently in
your laboratory area (s). You should review these rules with all employees after they are
prepared, with each new employee, and with all employees at least annually.
*11.
Attach a copy of your emergency procedures.
These procedures should include the names and telephone numbers of key lab personnel as
well as the Radiation Safety personnel to be contacted in case of emergency, and shall be
posted prominently in work areas where radioactive materials are used. You should review
these procedures with each new employee, and with all employees at least annually.
*12.
Describe the frequency and methods for routine area surveys. Weekly and monthly wipe test
services will be provided by Radiation Safety. Daily surveys, if required, are the
responsibility of the authorized user.
*13.
Attach a description of methods to be used for waste disposal. Include approximate amounts
to be disposed of through sewage or to be transferred to drums for contracted disposal at a
burial site.
*14.
Provide detailed procedures and necessary precautions in handling animal excreta, bedding,
carcasses or live animals during and after administration or radioactive material.
*15.
This is a statement signed by the individual named as Permit Administrator, certifying that the
information presented is true and correct.
*16.
Signature of Division Head/Department Chairman of individual named as Permit
Administrator.
*
Environmental Health & Safety will assist with these items. Complete a rough draft of page 1 of
the application and mail it to EHS. Upon receipt, the Radiation Safety Specialist will schedule a
consultation with you to assist in completing these items.
UTMB
APPLICATION FOR RADIOACTIVE MATERIALS USE PERMIT
1. Authorized User (s)
2. Authorized Use (s)
3. This is an application for
a.__ New Permit #_____
b.__ Renewal of permit #____
c.___Amendment to permit #___
Changes:
4. Usage and storage locations
5. RADIOACTIVE MATERIAL INFORMATION
Radionuclide
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Form
Maximum
mCi/experiment
Maximum mCi
in Inventory
Intended
Use
6.
Technical staff (list attached)
7.
Training and experience (check one)


Supplement A attached for each Authorized User
Supplement B & C attached for each Authorized user (human use)
8.
Instrumentation and Calibration Procedures (information attached)
9.
Facilities and Equipment (description & diagram attached)
10.
Rules for the safe use of radioactive materials (rules attached)
11.
Emergency procedures (procedures attached)
12.
Area survey procedures (procedures attached)
13.
Waste disposal (information attached)
14.
Procedures and precautions for the use of radioactive material in animals (detail information
attached)
15.
CERTIFICATE:
I certify as an Authorized user that this application is prepared in
conformity with the UTMB Radiation Safety Programs and that all information contained
herein, including any supplements attached hereto, is true and correct to the best of my
knowledge and belief.
16.
APPLICANT (Signature)
_______________________________________________
NAME (Type or Print)
_______________________________________________
DATE
_______________________________________________
RECOMMENDATIONS
A. PERMIT ADMINISTRATOR_______________________________________________
(Signature)
NAME (Type or Print)
________________________________________________
DATE
________________________________________________
 For approval

For disapproval
B. DEPT. CHAIRMAN/DIVISION
HEAD
________________________________________________
(Signature)
NAME (Type or Print)
________________________________________________
DATE
________________________________________________
 For approval

For disapproval
SUPPLEMENT A: TRAINING AND EXPERIENCE HISTORY – NON-HUMAN STUDIES
1.
NAME OF APPLICANT
2.
TRAINING
Field of
Training
Location and Date (s)
of Training
Type and Length of Training
Lecture &
Supervised
Laboratory
Laboratory
Courses
Experience
(Hours)
(Hours)
a. Radiation Physics
and Instrumentation
b. Radiation Protection
c. Mathematics Pertaining
to Use and Measurement
of Radioactive
d. Radiation Biology
e. Radionuclide Techniques
3. EXPERIENCE (Actual Use of Radionuclides or Equivalent Experience)
Radionuclide
Maximum Amount
per Experiment
Where Experience
was Gained
Duration of
Experience
Type of Use
4.
RECOMMENDATION (Submit a letter of recommendation from one of the individuals under
whom you were trained or the Radiation Safety Office of the last employer where you worked
with radiation.)
5.
I certify that the above information is true and correct to the best of my knowledge and belief.
__________________________________________
Signature of Applicant
INSTRUCTIONS FOR COMPLETING SUPPLEMENT A TRAINING AND EXPERIENCE
HISTORY: NON-HUMAN USE
A faculty member who wishes to be authorized to use or supervise the use of radionuclides for animal or in
vitro studies at UTMB should have training in basic radionuclide handling techniques and their procedures
commensurate with the type and quantities of radioactive material being requested.
Each applicant for authorization to use radioactive material for non-human studies should complete
Supplement A to document such training and experience.
1.
Self-explanatory.
2.
For each subject, list the institution where training was obtained, the date (s) of the training, the
number of actual classroom hours (for didactic portion) and the number of hours of supervised
laboratory experience.
3.
Self-explanatory.
4.
Submit a letter of recommendation from an individual who has first-hand knowledge of your
training and/or experience. The letter should outline the types and quantities of material used,
types of operations, evaluation of your ability handle radioactive material safely, your ability to
perform and evaluate contamination surveys, your knowledge of applicable rules and policies,
your length of experience and any knowledge of formal training you have received. The letter of
recommendation may also come from the Radiation Safety Office (or its equivalent) of the last
institution at which you were authorized to use radioactive material or radiation-producing
devices.
5.
Self-explanatory.