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UNIVERSITY OF HOUSTON Radiation Safety Manual Declaration of Pregnancy Form Section I. Voluntary Declaration of Pregnancy In accordance with the Texas regulations for Control of Radiation in 25 TAC 289. 202 m 1 Dose equivalent to an embryo/fetus I voluntarily declare that I am pregnant. My estimated date of conception is Month and year as regulatory required* I understand that the dose equivalent to my embryo/fetus during my entire pregnancy will not be allowed to exceed 0. 5 rem 5 mSv...

How to fill out pregnancy declaration form

How to fill out University of Houston Radiation Safety Manual Declaration of Pregnancy

1. Obtain a copy of the University of Houston Radiation Safety Manual Declaration of Pregnancy form.
2. Read the instructions carefully to understand the requirements.
3. Fill in your personal information including your name, student ID, and contact details.
4. Indicate that you are declaring your pregnancy by checking the appropriate box.
5. Include the expected due date if known.
6. Sign and date the form to certify the information provided.
7. Submit the completed form to the designated radiation safety office or coordinator.

Who needs University of Houston Radiation Safety Manual Declaration of Pregnancy?

1. Any pregnant student or employee who might be exposed to radiation as part of their academic or work duties at the University of Houston.

People Also Ask about

What is 10 and 28 day rule?

10 & 28 DAY RULES: These rules refer to the point in the Individual's menstrual cycle when it is considered most likely that the untoward effects of radiation in pregnancy can be avoided.

What is the recommended safe level of rad exposure per year?

ICRP: Recommends a limit of radiation exposure to a member of the general public as 100 mrem (1 mSv) per year and the limit for the fetus of an occupationally exposed individual to 200 mrem (2 mSv) during the gestation period.

Why 10 day rule radiology?

The “10 day rule” recommended that, in women of child-bearing potential, non-urgent x ray examinations that entailed pelvic irradiation should be restricted to the first 10 days of the menstrual cycle. Its rationale was to avoid irradiating a fetus before the mother realised that she was pregnant.

What is the radiation policy for pregnancy?

Standards for Protection Against Radiation that the dose equivalent to the fetus due to occupational exposure of a declared pregnant worker be kept below 500 mrem (5 mSv) during the pregnancy.

When a worker declares her pregnancy in writing the RSO is required to?

If I declare my pregnancy in writing, what happens? If you choose to declare your pregnancy in writing, the licensee must take measures to limit the dose to your embryo/fetus to 0.5 rem (5 millisievert) during the entire pregnancy. This is one-tenth of the dose that an occupational worker may receive in a year.

What is the declaration of pregnancy?

The Declaration of Pregnancy is a voluntary process that includes a written notification of the pregnancy by a radioactive material user to EH&S. This process includes a counseling session with the Radiation Safety Officer (RSO).

What is the 10-day rule in radiology?

What is the 10-day rule? The 10-day rule was established by the International Commission on Radiological Protection to minimize the potential for performing x-ray exams on pregnant women. The basis of the rule was to do abdominal and pelvic x-ray exams only during the 10 days following the onset of menstruation.

Is a pregnant radiation worker required to declare her pregnancy in writing?

In the United States, pregnant employees who work with or around radiation have the option of declaring their pregnancy. This declaration is voluntary and informs the worker's employer in writing of their pregnancy as well as the estimated date of conception.

What does a declared worker mean in radiology?

A declared pregnant worker is a woman who voluntarily informs her employer, in writing, of her pregnancy and gives the estimated date of conception.

Can you work with radiation while pregnant?

Most of the ways a pregnant woman may be exposed to radiation, such as from a diagnostic medical exam or an occupational exposure within regulatory limits, are not likely to cause health effects for a fetus. However, accidental or intentional exposure above regulatory limits may be cause for concern.

What is 10day rule?

The guiding principle is the 10-day rule stating that the abdominal area (lumbar spine, pelvis, coccyx, and hips) should not be irradiated after the 1st 10 days of one's menstrual cycle.

What is a declared worker in radiation?

Nuclear Regulatory Commission (NRC) Under NRC's definitions (10 CFR 20.1003), a declared pregnant worker is a worker who has voluntarily informed the employer, in writing, of the pregnancy and the estimated date of conception.

What happens when a radiographer is pregnant?

A pregnant worker can continue working in an X-ray department as long as there is reasonable assurance that the fetal dose can be kept below 1 mGy during the pregnancy.

What is 28 day rule in radiology?

They state that radiological procedures that deliver low doses to the fetus should be restricted to the first 28 days of last menstrual cycle, while those that deliver high fetal doses (> 0.01Gy to the fetus) as pelvic computed tomography (CT) and contrast radiological procedures should be restricted to the first 10

Are pregnant radiation workers required to declare their pregnancy?

You are not required to disclose the pregnancy to anyone outside of Radiation Safety. However, if your job duties or schedule must be modified in order to comply with the 500-mrem limit, then your department and your Human Resources representative must be included in this process.

What is declaration of pregnancy in radiology?

The Declaration of Pregnancy is a voluntary process that includes a written notification of the pregnancy by a radioactive material user to EH&S. This process includes a counseling session with the Radiation Safety Officer (RSO).

Why should a pregnant radiographer declare a pregnancy?

Declaring Pregnancy If you are a radiation worker and are pregnant, State and Federal regulations allow you to reduce your occupational exposures to below 500 mrem during pregnancy by declaring the pregnancy in writing to Radiation Safety.

What is the Nuclear Regulatory Commission radiation exposure limit for the full length of a pregnancy?

The Nuclear Regulatory Commission (NRC) Standards for Protection Against Radiation (10 CFR 20) require licensees to limit exposure to the embryo/fetus of an occupationally exposed individual to 500 mrem (5 mSv) or less during pregnancy for a declared pregnant worker who is exposed to radiation from licensed radioactive

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What is University of Houston Radiation Safety Manual Declaration of Pregnancy?

The University of Houston Radiation Safety Manual Declaration of Pregnancy is a formal notification that allows pregnant individuals working in areas with radiation exposure to communicate their condition to the institution, enabling them to receive appropriate safety measures.

Who is required to file University of Houston Radiation Safety Manual Declaration of Pregnancy?

Individuals who are pregnant and work in areas where radiation exposure may occur are required to file the Declaration of Pregnancy.

How to fill out University of Houston Radiation Safety Manual Declaration of Pregnancy?

To fill out the Declaration of Pregnancy, individuals must provide their personal information, the estimated date of delivery, and any additional details required by the form, and then submit it to the radiation safety officer.

What is the purpose of University of Houston Radiation Safety Manual Declaration of Pregnancy?

The purpose of the Declaration of Pregnancy is to ensure the safety and health of the pregnant individual and their fetus by identifying potential radiation exposures and implementing suitable protective measures.

What information must be reported on University of Houston Radiation Safety Manual Declaration of Pregnancy?

The form requires reporting personal information such as the individual's name, department, expected due date, and any relevant details about their work environment related to radiation exposure.