Online Radioactive Material Approval Form

Please complete this form to receive approval to order radioactive material.
Remember:

The IBT Safety Office does not place orders for radioactive material. The lab is responsible for contacting the vendor & placing the order once approval is obtained from the Safety Office.
Check your lab's inventory prior to ordering so that you do not go over your PI's limit for that isotope.

Requestor Information
First name :
Last name :
Phone extension :	(###-####)
Email :
Confirm Email :
Radioactive Material Information
Isotope:
Chemical Form:
Activity (in uCi):
Vendor:
Catalogue Number:
Anticipated Delivery Date: (mm/dd)	month / day
Sub-Licence Information
For the Lab of Dr.:
Storage in room: