Permit Request • CampusOptics

Authorization and Use of Personal Dosimeter Badges for Portable XRF Analyzer Users\

Individuals using a Portable XRF Analyzer must be authorized through a permit and are required to wear a personal dosimeter badge. To obtain a dosimeter from CSN Environmental Health & Safety (EH&S), applicants must complete all required safety training and provide the necessary information. Student permits are typically issued on a per-semester basis, while faculty and staff may receive extended authorization.

Dosimeters must be worn in compliance with Section 15.0: Dosimetry of the CSN Radiation Safety Manual. Prior to using a Portable XRF Analyzer, all faculty, staff, and students must:

Complete initial safety training by viewing the Bruker XRF Safety Training Video, and
Review Appendix D: Safe Operating Procedures for Handheld X-Ray Fluorescence (XRF) Analyzers in the CSN Radiation Safety Manual.

In accordance with NAC 459, all individuals who may be exposed to radiation must also download and review the NRC Regulatory Guide 8.13: Instruction Concerning Prenatal Radiation Exposure. Those who are pregnant or planning to become pregnant must complete the declaration form included in the guide and submit it to their authorized program. The program must retain the signed declaration on file.

For assistance please contact CSN EH&S at 702-651-7445 or ehs@csn.edu.

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Section 1: Applicant Information

User Status:* Required

Are you 18 years of age or older?* Required

Date of Birth:* Required

Section 2: Department/Course Information

Academic Program/Course:* Required

Supervisor/Instructor:* Required

Section 3: User Acknowledgements

Have you previously worn a radiation dosimeter?* Required

Have you completed viewing the Bruker XRF Safety Training Video?* Required

Date completed viewing the Bruker XRF Safety Training Video:* Required

Have you received and reviewed a copy of Append D of the CSN Radiation Safety Manual?* Required

Date you received and reviewed a copy of Append D of the CSN Radiation Safety Manual:* Required

Have you received and reviewed a copy of the NRC Regulatory Guide 8.13 Instruction Concerning Prenatal Radiation Exposure?* Required

Date you received a copy of the NRC Regulatory Guide 8.13:* Required

By accepting your personal dosimeter, do you acknowledge that, in accordance with the CSN Radiation Safety Manual, it is to be used only during school-related activities, and when not in use, it must be stored in your program's designated dosimetry storage location?* Required

Date of acceptance:* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files