{"id":422,"date":"2018-10-12T16:18:01","date_gmt":"2018-10-12T16:18:01","guid":{"rendered":"https:\/\/wp.uthscsa.edu\/safety\/?page_id=422"},"modified":"2021-09-24T16:59:52","modified_gmt":"2021-09-24T21:59:52","slug":"dosimetry","status":"publish","type":"page","link":"https:\/\/wp.uthscsa.edu\/safety\/divisions\/dosimetry\/","title":{"rendered":"Dosimetry"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column width=&#8221;2\/3&#8243;][vc_column_text]<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_15_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_xutmr\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Dosimetry<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"15\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_15\" id=\"frm_hide_fields_15\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"xutmr\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_15\" name=\"frm_submit_entry_15\" value=\"3fa9acfa7f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/safety\/wp-json\/wp\/v2\/pages\/422\" \/><div id=\"frm_field_154_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\"> Section 1: Participant Data<\/h3>\r\n<div id=\"frm_desc_field_xdo31\" class=\"frm_description frm_section_spacing\"> As required in the Texas Administrative Code, Chapter 25, \u00a7289.202, the following information regarding your radiation exposure history this calendar year is necessary for assessment of dosimetry service. <\/div>\r\n\r\n<div id=\"frm_field_156_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_nccjd\" class=\"frm_primary_label\"> Full Name: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nccjd\" name=\"item_meta[156]\" value=\"\"  data-sectionid=\"154\"  data-reqmsg=\" Full Name:  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_157_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_zit4u\" class=\"frm_primary_label\">Employee Identification Number:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_zit4u\" name=\"item_meta[157]\" value=\"\"  data-sectionid=\"154\"  data-reqmsg=\"Employee Identification Number: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_158_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_x9yei\" class=\"frm_primary_label\"> Date of Birth:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_x9yei\" name=\"item_meta[158]\" value=\"\"  data-sectionid=\"154\"  data-reqmsg=\" Date of Birth: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_159_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_5ddbe\" class=\"frm_primary_label\">Gender:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[159]\" id=\"field_5ddbe\"  data-sectionid=\"154\"  data-reqmsg=\"Gender: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Gender: is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"Male \">Male <\/option><option  value=\"Female\">Female<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_160_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_342x3\" class=\"frm_primary_label\">Over the age of 18?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_160-154-0\">\t\t\t<label  for=\"field_342x3-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[160]\" id=\"field_342x3-0\" value=\"Yes\"\n\t\t data-sectionid=\"154\"  data-reqmsg=\"Over the age of 18? cannot be blank.\" data-invmsg=\"Over the age of 18? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_160-154-1\">\t\t\t<label  for=\"field_342x3-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[160]\" id=\"field_342x3-1\" value=\"No\"\n\t\t data-sectionid=\"154\"  data-reqmsg=\"Over the age of 18? cannot be blank.\" data-invmsg=\"Over the age of 18? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_161_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_kzybe\" class=\"frm_primary_label\">Office phone number:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_kzybe\" name=\"item_meta[161]\" value=\"\"  data-sectionid=\"154\"  data-reqmsg=\"Office phone number: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_162_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_f4sxc\" class=\"frm_primary_label\"> List any other name(s) under which you have been monitored: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[162]\" id=\"field_f4sxc\" rows=\"5\"  data-sectionid=\"154\"  data-reqmsg=\" List any other name(s) under which you have been monitored:  cannot be blank.\" aria-required=\"true\" data-invmsg=\" List any other name(s) under which you have been monitored:  is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_163_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"> Section 2: Select the appropriate response: <\/h3>\r\n\r\n\r\n<div id=\"frm_field_165_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_1j3kn\" class=\"frm_primary_label\"> (a) I will work with 3H, 14C, 35S, 33P, 125I only: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_165-163-0\">\t\t\t<label  for=\"field_1j3kn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[165]\" id=\"field_1j3kn-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (a) I will work with 3H, 14C, 35S, 33P, 125I only:  cannot be blank.\" data-invmsg=\" (a) I will work with 3H, 14C, 35S, 33P, 125I only:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_165-163-1\">\t\t\t<label  for=\"field_1j3kn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[165]\" id=\"field_1j3kn-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (a) I will work with 3H, 14C, 35S, 33P, 125I only:  cannot be blank.\" data-invmsg=\" (a) I will work with 3H, 14C, 35S, 33P, 125I only:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_1j3kn\">If yes, no dosimeter required<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_167_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_ojiw0\" class=\"frm_primary_label\"> (b) I will work with 32P or 36Cl >1 mCi per protocol: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_167-163-0\">\t\t\t<label  for=\"field_ojiw0-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[167]\" id=\"field_ojiw0-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (b) I will work with 32P or 36Cl &gt;1 mCi per protocol:  cannot be blank.\" data-invmsg=\" (b) I will work with 32P or 36Cl &gt;1 mCi per protocol:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_167-163-1\">\t\t\t<label  for=\"field_ojiw0-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[167]\" id=\"field_ojiw0-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (b) I will work with 32P or 36Cl &gt;1 mCi per protocol:  cannot be blank.\" data-invmsg=\" (b) I will work with 32P or 36Cl &gt;1 mCi per protocol:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ojiw0\">If yes, no dosimeter required<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_169_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_qlp42\" class=\"frm_primary_label\"> (c) I will work with 32P or 36Cl >10 mCi per protocol: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_169-163-0\">\t\t\t<label  for=\"field_qlp42-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[169]\" id=\"field_qlp42-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (c) I will work with 32P or 36Cl &gt;10 mCi per protocol:  cannot be blank.\" data-invmsg=\" (c) I will work with 32P or 36Cl &gt;10 mCi per protocol:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_169-163-1\">\t\t\t<label  for=\"field_qlp42-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[169]\" id=\"field_qlp42-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (c) I will work with 32P or 36Cl &gt;10 mCi per protocol:  cannot be blank.\" data-invmsg=\" (c) I will work with 32P or 36Cl &gt;10 mCi per protocol:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qlp42\">If yes, dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_170_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_ngmbu\" class=\"frm_primary_label\"> (d) I will work with 86Rb, 22Na, 51Cr,131I >1 mCi per protocol: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_170-163-0\">\t\t\t<label  for=\"field_ngmbu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[170]\" id=\"field_ngmbu-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (d) I will work with 86Rb, 22Na, 51Cr,131I &gt;1 mCi per protocol:  cannot be blank.\" data-invmsg=\" (d) I will work with 86Rb, 22Na, 51Cr,131I &gt;1 mCi per protocol:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_170-163-1\">\t\t\t<label  for=\"field_ngmbu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[170]\" id=\"field_ngmbu-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (d) I will work with 86Rb, 22Na, 51Cr,131I &gt;1 mCi per protocol:  cannot be blank.\" data-invmsg=\" (d) I will work with 86Rb, 22Na, 51Cr,131I &gt;1 mCi per protocol:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ngmbu\">If yes, dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_171_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_qjegr\" class=\"frm_primary_label\"> (e) I will work with fluoroscopy or radiographic equipment: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_171-163-0\">\t\t\t<label  for=\"field_qjegr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[171]\" id=\"field_qjegr-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (e) I will work with fluoroscopy or radiographic equipment:  cannot be blank.\" data-invmsg=\" (e) I will work with fluoroscopy or radiographic equipment:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_171-163-1\">\t\t\t<label  for=\"field_qjegr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[171]\" id=\"field_qjegr-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (e) I will work with fluoroscopy or radiographic equipment:  cannot be blank.\" data-invmsg=\" (e) I will work with fluoroscopy or radiographic equipment:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qjegr\">If yes, dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_172_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_8ruqn\" class=\"frm_primary_label\"> (f) I will work with PET or nuclear medicine isotopes: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_172-163-0\">\t\t\t<label  for=\"field_8ruqn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[172]\" id=\"field_8ruqn-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (f) I will work with PET or nuclear medicine isotopes:  cannot be blank.\" data-invmsg=\" (f) I will work with PET or nuclear medicine isotopes:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_172-163-1\">\t\t\t<label  for=\"field_8ruqn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[172]\" id=\"field_8ruqn-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (f) I will work with PET or nuclear medicine isotopes:  cannot be blank.\" data-invmsg=\" (f) I will work with PET or nuclear medicine isotopes:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_8ruqn\">If yes, dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_173_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_neay5\" class=\"frm_primary_label\"> (g) I will work for Environmental Health & Safety: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_173-163-0\">\t\t\t<label  for=\"field_neay5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[173]\" id=\"field_neay5-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (g) I will work for Environmental Health &amp; Safety:  cannot be blank.\" data-invmsg=\" (g) I will work for Environmental Health &amp; Safety:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_173-163-1\">\t\t\t<label  for=\"field_neay5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[173]\" id=\"field_neay5-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (g) I will work for Environmental Health &amp; Safety:  cannot be blank.\" data-invmsg=\" (g) I will work for Environmental Health &amp; Safety:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_neay5\">If yes, dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_174_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_ki6o6\" class=\"frm_primary_label\"> (h) I am a voluntarily declared pregnant worker: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_174-163-0\">\t\t\t<label  for=\"field_ki6o6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[174]\" id=\"field_ki6o6-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (h) I am a voluntarily declared pregnant worker:  cannot be blank.\" data-invmsg=\" (h) I am a voluntarily declared pregnant worker:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_174-163-1\">\t\t\t<label  for=\"field_ki6o6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[174]\" id=\"field_ki6o6-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (h) I am a voluntarily declared pregnant worker:  cannot be blank.\" data-invmsg=\" (h) I am a voluntarily declared pregnant worker:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ki6o6\">If yes, contact Radiation Safety Office <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_175_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_l9nb5\" class=\"frm_primary_label\"> (i) I will work with Dental X-ray equipment: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_175-163-0\">\t\t\t<label  for=\"field_l9nb5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[175]\" id=\"field_l9nb5-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (i) I will work with Dental X-ray equipment:  cannot be blank.\" data-invmsg=\" (i) I will work with Dental X-ray equipment:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_175-163-1\">\t\t\t<label  for=\"field_l9nb5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[175]\" id=\"field_l9nb5-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (i) I will work with Dental X-ray equipment:  cannot be blank.\" data-invmsg=\" (i) I will work with Dental X-ray equipment:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_l9nb5\">If yes, no dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_176_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_c95dx\" class=\"frm_primary_label\"> (j) I will work with Brachytherapy or LINAC Procedures: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_176-163-0\">\t\t\t<label  for=\"field_c95dx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[176]\" id=\"field_c95dx-0\" value=\"Yes\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (j) I will work with Brachytherapy or LINAC Procedures:  cannot be blank.\" data-invmsg=\" (j) I will work with Brachytherapy or LINAC Procedures:  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_176-163-1\">\t\t\t<label  for=\"field_c95dx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[176]\" id=\"field_c95dx-1\" value=\"No\"\n\t\t data-sectionid=\"163\"  data-reqmsg=\" (j) I will work with Brachytherapy or LINAC Procedures:  cannot be blank.\" data-invmsg=\" (j) I will work with Brachytherapy or LINAC Procedures:  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_c95dx\">If yes, dosimeter required <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_177_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_other_container\">\r\n    <label for=\"field_j90nj\" class=\"frm_primary_label\"> Classification: If other, please specify: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[177]\" id=\"field_j90nj\"  data-sectionid=\"163\"  data-reqmsg=\" Classification: If other, please specify:  cannot be blank.\" aria-required=\"true\" data-invmsg=\" Classification: If other, please specify:  is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"Faculty\">Faculty<\/option><option  value=\"Laboratory Staff\">Laboratory Staff<\/option><option  value=\"Student\">Student<\/option><option  value=\"Resident\">Resident<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Other<\/option>\t<\/select>\n\t<label for=\"field_j90nj-otext\" class=\"frm_screen_reader frm_hidden\"> Classification: If other, please specify: <\/label><input type=\"text\" id=\"field_j90nj-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][177]\" value=\"\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_179_container\" class=\"frm_form_field  frm_html_container form-field\"> With which Authorized User, Principal Investigator, or Department will you be working? <\/div>\n<div id=\"frm_field_184_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_q56ug\" class=\"frm_primary_label\"> Authorized User: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_q56ug\" name=\"item_meta[184]\" value=\"\"  data-sectionid=\"163\"  data-reqmsg=\" Authorized User:  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_183_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ttsuq\" class=\"frm_primary_label\">Principal Investigator: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ttsuq\" name=\"item_meta[183]\" value=\"\"  data-sectionid=\"163\"  data-reqmsg=\"Principal Investigator:  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_182_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ic7wt\" class=\"frm_primary_label\"> Department: \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ic7wt\" name=\"item_meta[182]\" value=\"\"  data-sectionid=\"163\"  data-reqmsg=\" Department:  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_181_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_611e0a\" class=\"frm_primary_label\">Start Date:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_611e0a\" name=\"item_meta[181]\" value=\"\"  data-sectionid=\"163\"  data-reqmsg=\"Start Date: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_180_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_84dn8\" class=\"frm_primary_label\">End Date:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_84dn8\" name=\"item_meta[180]\" value=\"\"  data-sectionid=\"163\"  data-reqmsg=\"End Date: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_185_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"> Section 3: Previous employment(s) involving radiation exposure this calendar year <\/h3>\r\n\r\n\r\n<div id=\"frm_field_190_container\" class=\"frm_form_field  frm_html_container form-field\">If you answered \"yes\" to either of the above questions in Section 3, you must print out and sign this form before you press the Submit button. Please return the signed form to: Radiation Safety Division, Environmental Health & Safety, Room 1.343T Dental School.\t<\/div>\n<div id=\"frm_field_187_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_rr3x2\" class=\"frm_primary_label\"> Have you been occupationally exposed to radiation sources this calendar year at another institution? \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_187-185-0\">\t\t\t<label  for=\"field_rr3x2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[187]\" id=\"field_rr3x2-0\" value=\"Yes\"\n\t\t data-sectionid=\"185\"  data-reqmsg=\" Have you been occupationally exposed to radiation sources this calendar year at another institution?  cannot be blank.\" data-invmsg=\" Have you been occupationally exposed to radiation sources this calendar year at another institution?  is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_187-185-1\">\t\t\t<label  for=\"field_rr3x2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[187]\" id=\"field_rr3x2-1\" value=\"No\"\n\t\t data-sectionid=\"185\"  data-reqmsg=\" Have you been occupationally exposed to radiation sources this calendar year at another institution?  cannot be blank.\" data-invmsg=\" Have you been occupationally exposed to radiation sources this calendar year at another institution?  is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_rr3x2\">If Yes, you must print out and sign form<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_192_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_v2si\" class=\"frm_primary_label\">Facility Name:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_v2si\" name=\"item_meta[192]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"Facility Name: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_191_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_snruf\" class=\"frm_primary_label\">Department:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_snruf\" name=\"item_meta[191]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"Department: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_193_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_tvby7\" class=\"frm_primary_label\">Mailing Address:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[193]\" id=\"field_tvby7\" rows=\"5\"  data-sectionid=\"185\"  data-reqmsg=\"Mailing Address: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_195_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_imy9o\" class=\"frm_primary_label\">Start Date:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_imy9o\" name=\"item_meta[195]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"Start Date: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_194_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_cd5ft\" class=\"frm_primary_label\">End Date:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_cd5ft\" name=\"item_meta[194]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"End Date: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_188_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_v0g9m\" class=\"frm_primary_label\"> Does any concurrent employment to UTHSCSA require exposure to radiation sources this calendar year?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_188-185-0\">\t\t\t<label  for=\"field_v0g9m-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[188]\" id=\"field_v0g9m-0\" value=\"Yes\"\n\t\t data-sectionid=\"185\"  data-reqmsg=\" Does any concurrent employment to UTHSCSA require exposure to radiation sources this calendar year? cannot be blank.\" data-invmsg=\" Does any concurrent employment to UTHSCSA require exposure to radiation sources this calendar year? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_188-185-1\">\t\t\t<label  for=\"field_v0g9m-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[188]\" id=\"field_v0g9m-1\" value=\"No\"\n\t\t data-sectionid=\"185\"  data-reqmsg=\" Does any concurrent employment to UTHSCSA require exposure to radiation sources this calendar year? cannot be blank.\" data-invmsg=\" Does any concurrent employment to UTHSCSA require exposure to radiation sources this calendar year? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_200_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ams5l\" class=\"frm_primary_label\">Facility Name:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ams5l\" name=\"item_meta[200]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"Facility Name: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_202_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_2pm17\" class=\"frm_primary_label\">Department:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_2pm17\" name=\"item_meta[202]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"Department: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_x3f5w\" class=\"frm_primary_label\">Mailing Address:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[203]\" id=\"field_x3f5w\" rows=\"5\"  data-sectionid=\"185\"  data-reqmsg=\"Mailing Address: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_j1hd\" class=\"frm_primary_label\">Start Date:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_j1hd\" name=\"item_meta[204]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"Start Date: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9cps8\" class=\"frm_primary_label\">End Date:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_9cps8\" name=\"item_meta[205]\" value=\"\"  data-sectionid=\"185\"  data-reqmsg=\"End Date: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_206_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Section 4: Signature<\/h3>\r\n\r\n\r\n<div id=\"frm_field_232_container\" class=\"frm_form_field  frm_html_container form-field\">I authorize the release of my radiation exposure history to the University of Texas Health Science Center San Antonio and will notify Environmental Health & Safety in the event of changes to the above information. <\/div>\n<div id=\"frm_field_208_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_4sp31\" class=\"frm_primary_label\">Applicant Signature:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4sp31\" name=\"item_meta[208]\" value=\"\"  data-sectionid=\"206\"  data-reqmsg=\"Applicant Signature: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_209_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_k75kx\" class=\"frm_primary_label\">Date:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_k75kx\" name=\"item_meta[209]\" value=\"\"  data-invmsg=\"Date: is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_233_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_oyq52\" class=\"frm_primary_label\"> Permanent Address:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[233]\" id=\"field_oyq52\" rows=\"5\"  data-sectionid=\"206\"  data-invmsg=\" Permanent Address: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_258_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_259_container\">\n\t\t\t<label for=\"field_14fpe\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_14fpe\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[259]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"4HgOj5+vGu8uYHZ2dG9N2bx5R\/Qh310RgyWitUKNQVvaJMBR1fHbmAE\/5rOrjGRb\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;panel single-border single-border-top&#8221;]<\/p>\n<h2>For Questions<\/h2>\n<p>Contact 210-567-2955[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column width=&#8221;2\/3&#8243;][vc_column_text][\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;panel single-border single-border-top&#8221;] For Questions Contact 210-567-2955[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":310,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/child-page.php","meta":{"footnotes":""},"class_list":["post-422","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Dosimetry - Environmental Health and Safety<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/wp.uthscsa.edu\/safety\/divisions\/dosimetry\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dosimetry - Environmental Health and Safety\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column width=&#8221;2\/3&#8243;][vc_column_text][\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;panel single-border single-border-top&#8221;] For Questions Contact 210-567-2955[\/vc_column_text][\/vc_column][\/vc_row]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/wp.uthscsa.edu\/safety\/divisions\/dosimetry\/\" \/>\n<meta property=\"og:site_name\" content=\"Environmental Health and Safety\" \/>\n<meta property=\"article:modified_time\" content=\"2021-09-24T21:59:52+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/wp.uthscsa.edu\\\/safety\\\/divisions\\\/dosimetry\\\/\",\"url\":\"https:\\\/\\\/wp.uthscsa.edu\\\/safety\\\/divisions\\\/dosimetry\\\/\",\"name\":\"Dosimetry - Environmental Health and 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Health and Safety\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/wp.uthscsa.edu\\\/safety\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Dosimetry - Environmental Health and Safety","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/wp.uthscsa.edu\/safety\/divisions\/dosimetry\/","og_locale":"en_US","og_type":"article","og_title":"Dosimetry - Environmental Health and Safety","og_description":"[vc_row][vc_column width=&#8221;2\/3&#8243;][vc_column_text][\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;panel 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