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SAMPLE TRANSPORTATION INSTRUCTIONS
5.12
Radioactive material transport checklist
Date __________________________________Operator ____________________________________
Destination _________________________________________________________________________
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Transport container model ______________ Serial number________________________________
Radionuclide __________________________ Activity _____________________________________
Type of label applied ___________________ Transport index ______________________________
Survey meter model ____________________ Serial number ________________________________
Calibration date _______________________ Film badge __________________________________
Dosimeter serial number ________________ Initial reading ________________________________
Final reading ________________________________
Radiation area signs ____________________ Packing list __________________________________
Rope _________________________________ Bill of lading _________________________________
Radioactive material sign _______________ Emergency equipment ________________________
Radiation survey _______________________ Driver's compartment ________________ mRem/hr
(Record highest reading) Vehicle (18in from surface) ___________ mRem/hr
Packages properly marked and labeled (including transport index) ________________________
Packages secured in vehicle _____________ Vehicle placarded ____________________________
Shipping papers properly completed __________________________________________________
Remarks: ___________________________________________________________________________
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Operator's signature _________________________________________________________________