Application for Personnel Radiation Dosimeter

Environmental Health & Safety > Radiation Safety > Application for 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.

If you already have a radiation dosimeter, and need to change the name that appears on your dosimeter, please click here.

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 in 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:

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.

Promptly return your dosimeter at the end of the wear period, even if you did not wear it.

Do not wear your dosimeter outside of WU, WUSM, BJH, or SLCH facilities.

Wear your dosimeter as intended.

Chest dosimeters should be worn at chest level, facing forward, or at a location where the highest dose is likely.

Collar dosimeters should be worn at collar level, facing forward, on the outside of your lead apron.

Ring dosimeters should be worn so your name on the ring is facing towards the source of radiation.

I agree to comply