Figure 2 h
Renewal of
Radioisotope Permit
Section 1 – Identification
Name: __________________________________________________________________________________
Name
Surname
Previous Surname
Department:______________________________________________________________________________
Home Phone number: ___________ Office Phone Number: __________ Lab Phone Number: _____________
E-mail address: ______________________________________________________
Section 2 – Areas of Use
Laboratories that will be used for radioactive work (list all rooms that will be used for radioactive work include
coldroom, environmentally controlled room, equipment rooms for liquid scintillation or gamma counters, etc.)
Building_____________ Room Numbers ____________________________________________
Will radioactive materials be used in a cold or temperature controlled sealed room?
Yes
No
Building_____________ Room Numbers ____________________________________________
Section 3 – Open Sources
List open source radioactive materials which will be used, typical order size of the vials and total Possession
Limit for all your laboratories for the isotopes you will actually require to have in your possession at any one
time during the year. Vial order size determines the classification of the laboratory. See Annual limit of intake
Table (Figure 3-a). List the Radioisotope Possession Limit in MBq. Please add any isotopes that may be
required which are not listed.
Radioisotope
H-3
C-14
P-32
P-33
S-35
Cl-36
Ca-45
Cr-51
Vial order size
Possession Limit
Radioisotope
Vial order size
Possession Limit
Fe-59
Rb-86
Tc-99m
Cd-109
I-125
I-131
Ba-133
If greater than 10,000 exemption quantities (refer to figure 3-b) of nuclear substance will be used in an
experiment or purchased in a single vial Canadian Nuclear Safety Commission must be informed prior the
experiment and must approve the experimental protocol.
2012-08-30
Figure 2 h
Section 4 – Contamination Surveys
Which Liquid Scintillation Counter or Gamma Counter will laboratory personnel use for contamination surveys?
Model and Manufacturer:
____________________________________________
Building and Room location of counter:
____________________________________________
Section 5 – Nuclear Energy Workers
Please list all individuals who will use radioactive materials, and the radioisotopes to be used. Please send in
completed Figure 4 a.
Section 6 – Shipping and Receiving Nuclear Substances
Will you be receiving radioactive materials from any other research institutions? Yes
Institutions
Isotope
Activity
Will you be shipping radioactive materials to other research institutions?
Institutions
Isotope
Frequency
Yes
Activity
No
No
Frequency
Section 7 – Sealed Sources
List each sealed source that will be required or ordered, attach a list if more space is required:
Isotope and Activity____________________ Model and Manufacturer of Equipment_____________________
Isotope and Activity____________________ Model and Manufacturer of Equipment_____________________
Isotope and Activity____________________ Model and Manufacturer of Equipment_____________________
Section 8 – In Vivo Radioisotope Usage
Indicate the approved animal care protocol number (s) ______________. Attach a copy of the protocol and
complete a copy of figure 2-f.
Section 9 – Signatures
Applicants Signature:
Date:
Department Head Signature:
Date:
Radiation Safety Approval:
Date:
The information on this form is collected under the authority of the Freedom of Information and Protection of Privacy Act. It is required for the issuing of a Radioisotope Permit under the
University of Calgary Radioisotope Licence. This information will be provided to the Canadian Nuclear Safety Commission. Contact EH&S at 220-6347, if you have any questions about
the collection or use of this information.
2012-08-30