Appendix Pi Training Checklist
Appendix Pi Training Checklist
The following is a list of information which should be reviewed by the principal investigator with
all individuals frequenting any work area where there are radioactive materials. Please write a Yes,
No, or NA (Not Applicable) in the box provided next to the training item.
Y/N/NA
1. Right to Know Training has been completed.
2. ORCBS Radiation Safety Training has been completed.
3. ORCBS Chemical/Biological Safety Training has been completed.
4. ORCBS Bloodborne Pathogen Training has been completed.
5. The exposure limits for radiation have been reviewed with the worker (Refer to
instruction sheet for table).
6. Radiation warning symbols and their meanings have been reviewed with the
worker.
7. The locations of radioactive materials, hazardous chemicals and biohazardous
agents present in the laboratory have been pointed out to the worker.
8. The relative risks of being near to or using the hazardous agents present in the
laboratory have been reviewed with the worker.
9. The location and types of wastes and containers for the wastes have been
identified with the worker.
10. The proper procedures for emergencies which may arise in the laboratory have
been reviewed with the worker. This information includes the location of
emergency spill kits, emergency response telephone numbers and immediate
persons to contact in the laboratory if an emergency arises.
11. Security requirements for radioactive material have been reviewed with the
worker.
The following safety documents and/or safety manuals were reviewed by the worker. Note below.
a. Radiation Safety Manual
b. Chemical Hygiene Plan
c. Waste Disposal Guide
d. Other (Please list). ___________________________________
___________________________________
Worker Consent: I certify that I have been provided with and understand the information
indicated above. I understand that this is a certification of principal investigator training and
informed consent, and does not constitute a waiver of my rights. I understand that I am
responsible for adhering to all safety practices, laws, rules and guidelines.
_________________________________________________________________________
Worker Signature Date Title/Function
Principal Investigator: I certify that the above information was reviewed with or provided
to the above certified worker.______________________________________________________
Principal Investigator Signature Date
INSTRUCTIONS FOR PRINCIPAL INVESTIGATOR TRAINING
2. Training is function specific and site specific, meaning the content and depth of
training is related to the duties of the person and the scope of the hazards present in
the work area.
3. Exposure limits must be explained to workers. For persons who are not certified
radiation workers, the exposure limits are General Public, or 100 mrem per year.
For radiation workers, the limits are the occupational limits set forth in the 10 CFR
20 laws, or 5 rem per year TEDE (whole body), 50 rem per year to an organ, 15
rem per year to the lens of the eye, 50 rem per year for the skin of the whole body
and/or extremities. Radiation workers must have received introductory safety
training at the ORCBS, and must attend annual refreshers for radiation and
hazardous waste.
5. Security and control of radioactive materials must be provided at all times, either
with persons present or locking or securing to prevent tampering or unauthorized
use or removal. Persons who are not radiation workers may provide this control if
they are appropriately trained by the PI and/or the ORCBS radiation safety training
class.