Helpful Checklists

American Portable Nuclear Gauge Association

Printable Version License Preparation Checklist Security and Safety Checklist Shipping Checklist Paperwork Checklist

License Preparation Checklist

This is an example of a license preparation checklist. License applications vary from state to state. Make sure to use the license application, regulations, guidance and checklist from your state. You can access your state regulatory website by clicking on the “View Your State” section on the APNGA homepage.  The U.S. Nuclear Regulatory Commission’s NUREG-1556 series of technical reports (“Consolidated Guidance about Materials Licenses”) provide licensing guidance for many of the activities categorized above.

The documents are available on the Internet at http://www.nrc.gov/NRC/NUREGS/indexnum.html

U.S. Dept. of Transportation regulations (49 CFR) are available at http://www.access.gpo.gov/nara/cfr/index.html

Check the box when that section is complete 

Application Item Notes

 

1.a. Name/Mailing Address

   
  • Unless application is for an individual, list the registered business name
  • List the mailing address for license-related correspondence
     
 

1.b. Location of Use and/or Storage

   
  • List the street address where gauges will be used & stored, & where records will be available for inspection
  • Indicate if temporary job sites will be used as storage locations
     
 

2. License Category/Fee

   
  • List appropriate license category & application fee; there is no fee for license renewal Applications
  • Annual/reclamation fees are due within 60 days of license issuance and annually thereafter (an invoice for the fees is included w/ the new license)
     
 

3. Purpose of Application

   
  • Check appropriate box; if applying to renew a license, list the license number
     
 

4. Individual Users

   
  • List all authorized users (AUs), including the RSO
     
 

5. Rad. Safety Officer (RSO)

   
  • List the name of the RSO
     
 

6. Training and Experience in Radiation Safety

   
  • Enclose relevant documentation on the radiation safety training/experience for the RSO & each authorized user
     
 

7. Radioactive Material

   
  • List the element/source model no. & maximum activity for each source
     
 

8a. Use

   
  • List the manufacturer, model number & intended use for each source/device
     
 

8b. Current Radioactive Materials Inventory

   
  • For renewal applications, include current inventory of all Radioactive Materials, including exempt, generally licensed (GL) & specifically licensed (SL) sources/devices & indicate their status (exempt, GL or SL)
     
 

9. Radiation Detection Instruments

   
  • If applicable, list the manufacturer, model number, detection capability, range & probe specifications (if equipped w/ probe) of each instrument
  • Confirm access to an equivalent backup instrument when the primary meter is out due to calibration or repair
     
 

10. Calibration of Radiation Detection Instruments

   
  • If applicable, list the name & address of the instrument calibration vendor (may include option of using other licensed vendors) & confirm annual calibration frequency; if conducting in-house cal., submit procedures
     
 

11. Personnel Monitoring (PM) Devices

   
  • External PM required unless able to demonstrate that workers are unlikely to exceed 500 mrem/yr TEDE; if applicable, list PM badge type (FB/OSLD/TLD), supplier & exchange frequency (monthly/bimonthly/quarterly)
     
 

12. Facilities & Equipment

   
  • Annotated facility diagram shows gauge use/storage locations, access points., adjacent areas, proximity to occupied work stations, number of stories to building.
  • Description of storage container
  • Description of security measures in place to prevent access
  • Description of safety equipment
  • Description of postings
     
   

13. Radiation Protection Program

   
  • Description of program addressing below items
     
 

13a. Member of Public (MOP) Dose Study

   
  • New applicant: procedures for demonstrating compliance w/ MOP dose limits
  • License renewal: submit MOP study
     
 

13b. ALARA Policy

   
  •  Policy describes:  a) management’s commitment to ALARA philosophy, & b/ commitment to perform an annual ALARA/radiation protection program review
     
   

13c. Radiation Safety Officer

 

13c1. RSO Duties

   
  • Description of RSO duties
     
 

13c2. Change of RSO Notification

   
  •  Statement confirming that written notification will be given to the agency within 30 days of a change of RSO or other safety positions
     
 

13d. Radiation Safety Training Program

   
  • Training program addresses:
    • Instructions to workers/radiation awareness training
    • Authorized User training
    • Hazmat employee training per 49 CFR 172 Subpart H & driver training per 49 CFR 177.816
     
 

13e. Operating Procedures

   
  • Procedures address all applicable components listed below
  • Procedures include commitment that users are instructed in/have access to all procedures/manuals for each type of gauge
  • If applicable, procedures for transporting gauges to temporary job sites
     
 

13e1. Personnel Monitoring (PM) Procedures

   
  • External PM: Instructions on proper use: only use assigned PM badge, always wear badge when handling gauge, do not expose badge to excessive heat/light/chemicals/moisture, promptly return for exchange when due; use of spare badges; dealing w/ lost/damaged badges; PM records and annual/termination reports)
     
 

13e2. General Safety Rules

   
  • Procedures describe safety precautions for routine gauge use, applicable to requested Authorizations
     
 

13e3. Posting Procedures

   
  • Procedures address posting requirements
     
 

13e4. Security Procedures

   
  • Procedures address gauge security, including security at temporary job sites & overnight storage
     
 

13e5. Gauge Ordering, Receiving, Opening & Shipping Program

   
  • Instructions for preparation/handling of incoming & outgoing gauge shipments
     
 

13f. Emergency Procedures

   
  • Instructions for response to gauge loss, theft or damage; include emergency notification numbers for RSO & agency
     
 

13g. Leak Testing (LT) Procedures

   
  • Instructions for collecting LT samples; performed only by authorized users; state interval tests will be performed (6/12 months); list manufacturer name & model no. of LT kit used; list vendor contracted to analyze LT samples (may include option of using other licensed vendors)
     
 

13h. Inventory Procedures

   
  • Procedures address performance of physical inventories, describe inventory frequency (6/12 months) & record-keeping; include sample inventory form
     
 

13i. Record Retention Procedures

   
  • Procedures address record-keeping requirements
  • If applicable, include a commitment to maintain on file, for at least 1 year after the last shipment, copies of the testing methods & results for each Type A package in use (contact manufacturers for documentation)
     
 

14. Waste Disposal

   
  • Procedures address gauge disposal, with commitment that RAM will be transferred only to licensed recipients
     
 

15. Certificate

   
  • Application signed & dated by a certifying official (person authorized to make legally binding statements on behalf of the applicant

Security and Safety Checklist

Y
N  

Is the permanent storage area secured with two independent controls?

           
Y
N  

Is the storage area restricted from unauthorized individuals?

           
Y
N  

Is the gauge handle and gauge case locked?

           
Y
N  

Are alarms used on gauge storage access portals?

           
Y
N  

Are the outside areas around the storage area well lit?

           
Y
N  

Are “Caution Radioactive Materials” signs in place?

           
Y
N  

Are gauge users trained and authorized?

           
Y
N  

Have gauge users been trained in company safety and operating procedures and    have a copy of these procedures?

           
Y
N  

Have gauge users been trained in company safety and operating procedures and have a copy of these procedures?

           
Y
N  

Do gauge operators know what to do in the event of gauge theft or damage?

           
Y
N  

Do gauge operators have emergency contact numbers, including the RSO, regulatory agency and gauge manufacturer?

           
Y
N  

Have you checked to make sure the gauge is undamaged and in operational condition before check-out?

           
Y
N  

Is the gauge checked before removal to make sure sliding block is fully closed?

           
Y
N  

Has the gauge case been examined to make sure there are no holes, broken handles, hasps or handles, and no cracks?

           
Y
N  

Are gauges returned to permanent/authorized storage areas whenever possible?

           
Y
N  

Are gauges checked for current leak tests before check-out?

           
Y
N  

Are gauge service providers constantly monitored while working on gauges?

           
Y
N  

If you are in possession of radioactive quantities of concern have you restricted gauge service personnel that do not have authorized background clearance?

           
Y
N  

Have you made sure that any and all individuals that perform hazmat duties, including paperwork preparation, loading and unloading gauges, gauge delivery and return, and service and repair, receive U.S. DOT Hazmat training?

           
Y
N  

Have you instructed gauge users to constantly monitor and control gauges while in transport or at the job site?

           
Y
N  

Has the gauge been loaded in a properly qualified vehicle with two independent controls/locks?

           
Y
N  

Is the gauge loaded and secured in a non-passenger part of the vehicle?

           
Y
N  

Is the gauge blocked and braced?

           
Y
N  

Is the gauge concealed?

           
Y
N  

Are all gauge stickers, labels and markings in legible condition?

           
Y
N  

Whenever you leave the gauge unattended in a vehicle have you used vehicle theft deterrents such as vehicle alarms and steering wheel locks?

Shipping Checklist

Y
N  

Is the gauge case free of any damage including cracks, holes, broken hasps or broken handles?

           
Y
N  

Is the sliding block fully closed? Are radiation survey meter readings <10 millirem/hr at the surface of the package?

           
Y
N  

Are all labels on the gauge case fully intact and information on the labels legible?

         
  1. Two Yellow Radioactive II labels on opposite broadsides
    1. Names of nuclides listed
    2. Nuclides quantities listed in SI/becquerel and millicurie levels
    3. Transport Index (TI) number listed and legible
  2. One Type “A” Package label affixed next to Yellow Radioactive II Label
    1. RQ designation for gauge containing Americium 241
    2. UN 3332 designation
  3. Two Air Cargo Only labels on opposite broadsides

If using an overpack shipping box make sure to affix Yellow II Radioactive and Air Cargo Only labels

Make sure any “ship to” address marked on the case matches  the bill of lading address

           
Y
N  

Does the gauge have a current leak test?

           
Y
N  

Does the gauge have handle and case locks?

           
Y
N  

Are you using the correct bill of lading?

         
  1. Private carrier bill of lading for shipments to the worksite
  2. Common carrier bill of lading for ground transport with Signed Shipper’s Certification
  3. Air Cargo/Signed Shippers Declaration for Dangerous Goods bill of lading
           
Y
N  

Do shipping papers have the following entries/information:

         
  1. UN 3332 ID, Proper shipping name (Radioactive Materials), Hazard Class 7, Reportable Quantity (RQ) if applicable
  2. Name of radioactive sources (Cs137, Am241), quantities in SI units (Gbq)
  3. Type “A” Package designation
  4. Yellow Radioactive II Label designation
  5. Emergency Telephone Number
  6. Shipper Certification for Common Carrier and Air Transport
  7. Emergency Response sheet attached
  8. Case dimensions
  9. IAEA Special Form Certificates listed and attached
  10. Make sure to keep copies of all shipping documents, including dates, on file

Paperwork Checklist

 

Specific Gauge License

     
 

Regulations – A copy of the NRC or Agreement State Regulations

     
 

Employee Training Records

   
  • Gauge Safety Class Certification
  • U.S. DOT Hazardous Materials (HAZMAT) Training
  • RSO Training – If required
  • Annual Refresher – If required
     
 

Notice to Employees Poster

     
 

Personnel Gauge Radiation Exposure Records – Dosimetry Records

     
 

Inventory and Gauge Receipt Records

     
 

Leak Test Reports

     
 

Daily Utilization Logs

     
 

Daily Utilization Logs

     
 

Special Form Certificate required by IAEA – Certificate of Competent Authority

     
 

Sealed Source and Device (SSD) Sheets

     
 

Original License Application Package – Application + supporting documents

     
 

Extra Labels

     
 

Type “A” Package Test Results

     
 

Radiation Safety Program

     
 

Annual Audits

     
 

Transport Documents – Bills of lading + Emergency Response Sheet

     
 

Field Gauge Operating Procedures

     
 

Emergency Procedure Documents/Procedures/Plans

     
 

Gauge Documents Package for File and Gauge Case

   
  1. Copy of original gauge receipt with gauge and source serial numbers
  2. Copy of license
  3. Gauge manual
  4. Emergency procedures with contact names and telephone numbers
    1. RSO office, mobile & home number
    2. Regulatory agency emergency number
    3. Gauge manufacturer’s emergency number
    4. Local police number
    5. Local fire & rescue number
    6. NRC 24 hr emergency number 301-816-5100
    7. U.S. DOT 24 hr emergency number 800-424-8802
  5. Copy of Bill of Lading (Keep another copy within reach during transport
  6. Copy of Emergency Response Sheet (Keep another copy within reach during transport)
  7. Gauge Calibration data with telephone number for gauge manufacturer or service center
  8. Field operating procedures
  9. Emergency responder hand-out (police, fire, rescue, hazmat)
  10. Current Leak Test Report
  11. Media hand-out