radiation - McGill Medical Physics Unit - McGill University

DECOMMISSIONING REPORTPermit Holder: _________________ Internal Permit: __________________ Room #:_________Part A: To be completed by the Permit Holder1) Confirm that all radioactive materials have been properly disposed of. This includes sourcevials, by-products and waste (liquid, solid, and LSV).2) Please identify all areas and equipment used for radioactive work in this lab. A written listand a map are required. Please attach the documents to this form.YESYESNONO3) Were any drains used for radioactive work (e.g. disposal)? YES NO4) Were any fume hoods used? YES NO5) Confirm that all items/areas which may have been used for radioactive work have been:a) direct monitored (specify instrument and probe): _________________________ YES NOb) wipe tested. (Please attach results to this form) YES NO6) Confirm that all radiation warning labels have been removed from work areas andequipment. Do not remove door sign, lab classification posters and permit.I certify that the information entered in this form is valid.YESNOSignature: ______________________ Title: _______________________ Date:_________________Part B: To be completed by the Radiation Protection Service1) Checked survey results. YES NO2) Removal of warning signs verified. YES NO3) Comments:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4) Door signs, lab classification posters and permit removed. YES NO5) Permit removed from RPS database. Date removed: _____________________ YES NOSignature: _______________________ Title: _______________________ Date: ________________