Rutgers Environmental Health and Safety
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Instructions for Completing:
Report Isotope Order Form
Name:
Enter your name.
Email Address:
Enter your email address.
Authoree No.:
Enter the 4-digit number assigned to the authoree ordering the isotope.
Authoree Name:
Enter the name of the authoree ordering the isotope.
P.O. Number:
Enter the Purchase Order Number assigned to your isotope order.
Date Ordered:
Enter the date your order was placed with the vendor.
Vendor:
Enter the name of the vendor or company with whom you placed your order.
Building Name:
Enter the name of the building where the isotope is to be delivered.
Room No.:
Enter the room number where the isotope is to be delivered.
Amount:
Choose one of two choices from the pull-down menu:
mCi:
milliCuries.
uCi:
microCuries.
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.
