Please use this form if you will no longer be working with radioactive material/radiation at UNMC. If you are going to continue to work with radiation, but no longer require a radiation badge (e.g., working solely with H-3, C-14, S-35) contact the Radiation Safety Office.
All fields are required.
Name:
Authorized User (or Supervisor):
Department:
Contact Phone Number:
Email Address:
Effective Date Terminating Radiation Work:
Do You Wish to Have a Termination Report (Radiation History) Sent to You? Yes No
If Yes, provide an address to send the Termination Report To:
Street Address:
City: State: Zip: