{"id":5436,"date":"2023-09-28T15:45:42","date_gmt":"2023-09-28T20:45:42","guid":{"rendered":"https:\/\/uwm.edu\/safety-health\/?page_id=5436"},"modified":"2023-09-28T15:45:42","modified_gmt":"2023-09-28T20:45:42","slug":"6-month-x-ray-safety-test-checklist-2","status":"publish","type":"page","link":"https:\/\/uwm.edu\/safety-health\/6-month-x-ray-safety-test-checklist-2\/","title":{"rendered":"6-Month X-ray Safety Test Checklist"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_23' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">X-Ray Safety Device Test<\/h2>\n                            <p class='gform_description'>Regulations require Testing of Safety Devices for Radiation Generating Devices every 6 months, DHS 157.87(1)(j)<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_23'  action='\/safety-health\/wp-json\/wp\/v2\/pages\/5436' data-formid='23' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_bec7ca089528cf1fdac3a3dced30b276\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_bec7ca089528cf1fdac3a3dced30b276\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_23' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_23_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_23_26'>Device(s) being Tested:<\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_23_26' class='large gfield_select'     aria-invalid=\"false\" ><option value='Micro CT Scanner - Accelerator Building' >Micro CT Scanner - Accelerator Building<\/option><option value='Handheld XRF - Sabin' >Handheld XRF - Sabin<\/option><option value='Bruker D8 - EMS 1262' >Bruker D8 - EMS 1262<\/option><option value='Bruker Pioneer S4 - Lapham' >Bruker Pioneer S4 - Lapham<\/option><option value='Bruker Phaser - Lapham' >Bruker Phaser - Lapham<\/option><option value='DXA Scanner - Enderis' >DXA Scanner - Enderis<\/option><option value='Pronto Benchtop AXRD - KIRC' >Pronto Benchtop AXRD - KIRC<\/option><option value='Laue Camera - KIRC' >Laue Camera - KIRC<\/option><option value='Core Labs - NWQ Device' >Core Labs - NWQ Device<\/option><option value='Portable unit - NWQ Device' >Portable unit - NWQ Device<\/option><option value='Silhouette - NWQ Device' >Silhouette - NWQ Device<\/option><\/select><\/div><\/div><fieldset id=\"field_23_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Interlocks Working?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_23_5'><div class='gchoice gchoice_23_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Yes'  id='choice_23_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_5_1' id='label_23_5_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='No'  id='choice_23_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_5_2' id='label_23_5_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='N\/A'  id='choice_23_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_5_3' id='label_23_5_3' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Shutter &quot;Open&quot; Warning Lights Working?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_23_7'><div class='gchoice gchoice_23_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Yes'  id='choice_23_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_7_1' id='label_23_7_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='No'  id='choice_23_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_7_2' id='label_23_7_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='N\/A'  id='choice_23_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_7_3' id='label_23_7_3' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Warning Lights Indicating X-rays are &quot;On&quot; Working?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_23_8'><div class='gchoice gchoice_23_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Yes'  id='choice_23_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_8_1' id='label_23_8_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='No'  id='choice_23_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_8_2' id='label_23_8_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='N\/A'  id='choice_23_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_8_3' id='label_23_8_3' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_9\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emergency Shut-Off Button Working?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_23_9'><div class='gchoice gchoice_23_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.1' type='checkbox'  value='Yes'  id='choice_23_9_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_9_1' id='label_23_9_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_9_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.2' type='checkbox'  value='No'  id='choice_23_9_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_9_2' id='label_23_9_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_9_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.3' type='checkbox'  value='N\/A'  id='choice_23_9_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_9_3' id='label_23_9_3' class='gform-field-label gform-field-label--type-inline'>N\/A<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_10\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_23_10'>If any safety device fails during testing, the radiation generating device shall be removed from service until the safety device failure is corrected or proper temporary administrative controls are established and approved in writing by the person in control.  Corrective Actions:<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_23_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_23_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_23_11'>Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_23_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_23_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_23_12'>Building\/Room Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_23_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_23_13\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_23_13'>Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_23_13' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_23_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_23_13_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_23_13' class='gform_hidden' value='https:\/\/uwm.edu\/safety-health\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_23_14\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_23_14'>Survey Instrument (if used) -Leak tests will be performed at the Annual 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