Radiation Safety Assessment Checklist
General Information
Facility Name
Assessment Date
Assessor Name
1. Administrative Controls
Checklist Item
Yes
No
N/A
Comments
Are current radiation licenses and permits available and up-to-date?
Are personnel radiation training records maintained?
2. Engineering Controls
Checklist Item
Yes
No
N/A
Comments
Is shielding adequate and in good condition?
Are warning signs and labels present as required?
3. Personal Protective Equipment (PPE)
Checklist Item
Yes
No
N/A
Comments
Are appropriate PPE available and worn?
Are dosimeters issued and used as required?
4. Emergency Preparedness
Checklist Item
Yes
No
N/A
Comments
Are emergency procedures and contact numbers visibly posted?
Are spill kits and decontamination equipment available?
Additional Comments