Environmental Health & Safety > Radiation Safety > Application for Radiation Dosimeter
Application for Personnel Radiation Dosimeter
 
All fields other than Middle Initial are required.  Date of birth and employee ID are requested to help us identify you and ensure you get the proper dosimetry related materials.  If you have any questions, please contact Connie Turnbough at turnbouc@wustl.edu or 314-362-3475.
Applicant Information
Name: Last  First MI
Gender: Male Female
Date of Birth:
Phone Number: format: 999-999-9999
Email:
Confirm Email:
Department:
Position:
Occupational Information
Institution:
Employee ID:
Supervisor Name:
Supervisor Phone: format: 999-999-9999
Will your work with ionizing radiation involve using:
(Please check all that apply)
 
Radioactive materials
PET materials
 
X-ray generating machines
 
 
Exposure History
(Please check all that apply)
 
 
I was previously monitored for occupational radiation exposure at Barnes-Jewish Hospital, SL Children's Hospital, or Washington University.
 
 
I was monitored for occupational radiation exposure  at another institution.
 
 
I will be monitored for occupational radiation exposure at another institution while also working at Barnes, Children's, or Washington University.
Dosimetry Compliance Agreement
We require that all individuals receiving a dosimeter comply with the following:
1.
If you lose, damage, or accidentally expose your dosimeter, please report the incident to your department's dosimetry contact as soon as possible so a replacement dosimeter can be issued.
2.
Promptly return your dosimeter at the end of the wear period, even if you did not wear it.
3.
Do not wear your dosimeter outside of WU, WUSM, BJH, or SLCH facilities.
4.
Wear your dosimeter as intended.
 
a.
Chest dosimeters should be worn at chest level, facing forward, or at a location where the highest dose is likely.
 
b.
Collar dosimeters should be worn at collar level, facing forward, on the outside of your lead apron.
 
c.
Ring dosimeters should be worn so your name on the ring is facing towards the source of radiation.

  I agree to comply