Medical College of Wisconsin Office of Radiation Safety Forms

Clinical Use Applications

Non-Clinical Use Applications

Radiation Monitoring Badge Application-MCW (DOCX)
All non-clinical research personnel likely to receive 10% of the annual limits or working within 6 feet of a fluoroscopy device must be monitored for radiation exposure.

Radiation Monitoring Badge Application-Froedtert Hospital (XLS)
All clinical personnel likely to receive 10% of the annual limits or working within 6 feet of a fluoroscopy device must be monitored for radiation exposure.

Declaration of Pregnancy (DOCX)
Pregnant women working with radiation and who wish to limit fetal exposure to 500 mrem must notify ORS. Please see the complete Declaration of Pregnancy (DOCX) and visit the "Radiation and Pregnancy" section of the Training and Information FAQ  for more complete information.

These PDFs should be printed and placed in areas where radioactive material is used or stored.

State of Wisconsin Notice to Employees (PDF)

Supplement to the Notice to Employees (PDF)

Emergency Procedures (PDF)