APPLICATION TO USE RADIOACTIVE MATERIALS LABORATORY CHEMICALS ABOARD

Do Not Write in this Space

This application is approved with the following conditions for the time period _____________ to

______________.

______________________________________________________________

Signed by the Columbia University EH&S and Title

Date:

Name of Home Institution

Name of Primary Research Scientist (RS)

Name of Primary Principal Investigator (PI)

RS Email Address

PI Email Address

Home Institution EH&S Safety Contact Name

Home Institution EH&S Contact Phone and Email

List the members of your team that will be using hazardous chemicals and/or radioactive materials. Add additional lines if needed.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Brief description of the radioactive / chemical protocol(s) that will be conducted. Include the research objective, list radioisotopes and/or laboratory chemicals that will be used and, for each radionuclide, the maximum activity that will be on-board at any one time. Include sealed sources and radiation generating devices (e.g. core loggers, GC and electron capture devices, X-ray units, etc.)

Submit a copy of the MSDS (or SDS) for ALL chemicals, rad compounds, and incidental items (e.g. cleaners, solvents, lubricants, etc.)

Date SDS copies were received by CU Safety:

Columbia University expects that the research vessel and/or radioisotope use areas will be kept free of radioactive and chemical contamination (i.e. at background). Researcher(s) will be held responsible for all decontamination costs.

Describe the controls (engineering and administrative) to be used to control contamination.

Will radioactive gases or aerosols be generated as a result of activities? If yes, describe the controls (engineering and administrative) to be used to limit inhalation exposures to researchers and ship’s crew.

□ NO □ YES

Provide a copy of the Home Institution’s State or Federal license to conduct radioactive material work at sea.

NOTE: License needs to show radioactive materials in amounts to be used by the RS / PI.

Date license copy was received by Columbia RSO:

List the names of all personnel that will handle radioactive / chemical materials on the cruise.

NOTE: Summary of the training & experience in safe use of Radioactive/Chemical materials must be provided in separate letter. Include copies of current rad safety training certificates if available.

Provide shipping plans for how each radioisotope, sealed source, radiation generating device, and chemical will be transported to CU research vessel.

Provide details regarding what supplies, including personal protective equipment, workbench absorbent pads, scintillation fluid, swipes, secondary containment, decontamination supplies, etc. will be provided.

If applicable, indicate which radioisotopes (including activity) and chemical materials (and volumes) are expected to be transported back to the Home Institution after the cruise.

For Columbia researchers – personnel to ship materials back must be trained shippers.

Columbia PIs and waste. Provide details on all radioisotope waste, including activity and volumes, and chemical waste volumes expected to be produced. Indicate how wastes will be stored aboard ship.

Waste disposal: All such waste will need to be removed and disposed immediately at end of the cruise. Columbia University Hazardous Materials group will assist with arranging for pickup.

Disposal costs to be covered by the PI/RS through University approved waste vendor(s).

Non-Columbia PIs and waste. Provide details on all radioisotope waste, including activity and volumes, and chemical waste volumes expected to be produced. Indicate how wastes will be stored aboard ship.

NOTE: All such waste will need to be removed and disposed immediately at end of the cruise by the Home Institution.

Use of an appropriate waste vendor is required and it is the RS / PI’s responsibility to schedule and pay for disposal. No wastes are to be disposed at sea.

By prior written arrangement, and at the sole discretion of Columbia, Columbia University may accept non-Columbia waste for disposal with cost recovery.

For radioisotopes, Columbia University Radiation Safety Committee (CURSC) approval (not applicable if no radioisotopes are used):

CURSC Approval Date and

Chair Signature