Rutgers Environmental Health and Safety

Instructions for Completing:
Isotope Order Form

  1. Name:  Enter your name.
  2. Email Address:  Enter your email address.
  3. Authoree No.:  Enter the 4-digit number assigned to the authoree ordering the isotope.
  4. Authoree Name:  Enter the name of the authoree ordering the isotope.
  5. P.O. Number:  Enter the Purchase Order Number assigned to your isotope order.
  6. Date Ordered:  Enter the date your order was placed with the vendor.
  7. Vendor:  Enter the name of the vendor or company with whom you placed your order.
  8. Building Name:  Enter the name of the building where the isotope is to be delivered.
  9. Room No.:  Enter the room number where the isotope is to be delivered.
  10. Amount:  Choose one of two choices from the pull-down menu:

    mCi:  milliCuries.
    uCi:  microCuries.
  11. Isotope Type:  Select the isotope from the pull-down menu. If your selection is not listed, choose
    *Other and enter the isotope name in the space provided.