Radiation Safety Program Forms

URSC Application and Radiation Permit Change Forms

Application to Use Radioactive Materials or Ionizing Radiation Producing Devices

The use of radioactive materials and radiation producing devices such as x-ray machines at NMSU is subject to review and approval by the University Radiation Safety Committee (URSC).  The Application for Working with Ionizing Radiation is a multi-purpose application used by the URSC to review requests to use all types of ionizing radiation, radioactive materials and radiation producing devices. Instructions for completing the application can be found in Chapter 4 – User Authorization & Permitting of the NMSU Radiation Safety Manual.  Contact the Radiation Safety Manager if you have any questions about the application or application process.  Email the complete, signed application to the Radiation Safety Manager or mail a hard-copy through campus mail to Environmental Health & Safety / Attn: Radiation Safety Manager at MSC 3578.

URSC Permit Modification Form

To make modifications to an approved URSC Permit fill out a URSC Permit Modification/ Amendment Form and submit to the Radiation Safety Manager. Allow at least 7 business days for review and approval.  Examples of permit changes include:

  • Change in possession limits allowed under the permit
  • Change in the type of radioisotope authorized under the permit
  • Change to the locations where radioactive materials or devices can be used or stored
  • Changes to experimental protocols / procedures that were described in your original, approved URSC application.

Authorized Worker Change Form

To make changes (add or remove) to the personnel that are authorized to work with radioactive materials or radiation producing devices under your approved URSC Permit complete a Worker Change FormSubmit the completed form to the Radiation Safety Manager.  Contact the Radiation Safety Manager if you have any questions.

Required Area Signs and Postings

NMED 045 Notice to Workers

This notice is required to be posted in any area where the use radioactive material or a radiation-producing device (i.e x-ray machine) is authorized.  New Mexico Radiation Protection Regulations require that a copy of the Notice to Workers must be posted in a sufficient number of places in radiologically restricted areas (any area listed on a URSC Permit) so people who work in or frequent any portion of a restricted area can see the notice.

Emergency Procedures for Radioactive Material Areas

This two page form is required to be posted in a visible location in all areas where unsealed / un-encapsulated radioactive material is used or stored and includes:

  • Emergency contact information
  • Radioactive material spill clean up procedures
  • Personnel decontamination procedures
  • Procedures to follow in the event of an accidental release or loss of radioactive material