Permit Request • CampusOptics

Background Information:

UT Arlington complies with the Texas Department of State Health Services (TDSHS) Radiation Control Registration and Radiation Safety Requirements for General Provisions and Standards for Protection Against Machine-Produced Radiation under Title 25 Texas Administrative Code §289.231. The use of all radiation machines at UT Arlington is authorized by the Texas Department of State Health Services, Radiation Control under Certificate of X-Ray Registration Number R03595. The Radiation Safety Officer (RSO) must be informed of all radiation machines prior to work beginning to ensure compliance with the Texas Regulation for Control of Radiation and the University’s Certificate of X-Ray Registration. For purposes of this registration, a radiation producing machine is defined as any device capable of producing ionizing radiation except those devices with radioactive material as the only source of radiation.

Instructions and Responsibilities:

The Principal Investigator (PI) is responsible for completing the appropriate parts of this Radiation Producing Machine Registration (RPMR) and submitting the form to Environmental Health & Safety (EH&S) prior to the initiation of work. The PI is also responsible for ensuring appropriate or required training of laboratory personnel, informing lab personnel of the potential hazards and proper safety techniques to be used in the laboratory, establishing procedures for response and handling of laboratory emergencies, ensuring appropriate laboratory signage, and following UT Arlington established procedures for response and reporting of accidents and/or injuries.

After the initial registration, the PI is also responsible for notifying EH&S when the project has terminated or when other significant changes occur, such as changes in personnel or relocation of the radiation producing machine.

EH&S will audit the laboratory to ensure that the device and laboratory facility meets all safety requirements and is following all applicable policies and regulations. EH&S will assess training needs, provide dosimetry as required, and provide the appropriate lab signage.

EH&S conducts a preliminary and routine inspections as needed.

Depending on what your project involves there may be additional requirements necessary before the research may commence, such as research involving participation of human subjects, live vertebrate animals, recombinant DNA, or laser devices. These requirements are based on various federal and state regulations, funding agency requirements and UT-Arlington policies. For more information and instructions, please see this link: http://www.uta.edu/ra/oric/help.htm.

For assistance with this RPMR form, please contact EH&S at 817-272-2185 or ehsafety@uta.edu.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date

Expiration Time

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Radiation Producing Machine

UTA Property Inventory Number* Required

Manufacturer* Required

Model* Required

Serial Number* Required

Date received on campus* Required

Is it portable?* Required

Power, kV* Required

Current, Amp* Required

Frequency, Hz* Required

Is the Radiation Producing Machine Safety Manual available?* Required

Is the Manufacturer’s Manual(s) available?* Required

Is the Survey Meter Available & Calibrated?* Required

List Manufacturer, Model, & Serial Number of Survey meter.* Required

Have all authorized users taken the UTA Radiation Producing Machine Safety Training?* Required

Will the X-ray Device be used on human subjects?* Required

Emergency procedures are explained in the Standard Operating Procedure.* Required

Please describe in layman’s term, the procedure of the experimental work that will be done with the x-ray device.* Required

Personnel working with radiation producing machines

Attach document below with the following information on all personnel working with radiation producing machines: Last Name, First Name, Status (faculty, staff, student), Email address, UTA ID #* Required

Principal Investigator Certification

I accept responsibility for the safe use of all potential hazards in my laboratory. All laboratory personnel have been informed of the potential risks associated with working with these radiation producing machines. I will ensure proper laboratory practices and completion of training requirements for laboratory personnel. I will report any accidents, injuries, or exposures immediately to EH&S. I will also notify EH&S of any changes to this project, including change of location of the x-ray device or personnel. I will inform EH&S of purchases, transfers (including those on campus), and/or disposals of x-ray devices. I understand that such changes should be reported within 14 days so that EH&S will have ample time to meet the requirements of notification to the TDSHS, Radiation Control.* Required

Add Supporting Documents

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

Files