Queen's University Secure Forms Service

Queen's University Queen's University

EH&S: Radiation - Application for a Radioisotope User’s Permit

The personal information on this form is collected under the authority of the Royal Charter of 1841, as amended. Personal information collected on this form will be used to generate internal permits and to check against training records. If you have any questions or concerns about the information collected or how it will be used please contact the Environmental Health and Safety Department by telephone at 613-533-2999
Applicant Information
List all locations where radionuclides will be stored or used.
Location 1
Open Source Isotopes Required
Isotope 1
Sealed Source Isotopes Required
Sealed Source 1
Radioisotope Users
User 1
Radioisotope Use
Please submit in pdf, doc or docx format
Details of Experiment
Monitoring Equipment
Equipment 1
Project Dates
I understand that my staff and I must abide by the Canadian Nuclear Safety Act and University regulations. Failure to comply can result in the cancellation of my permit.