Document form for Joint-Use

Downloading the document form for Joint-Use

• （様式１−１）共同利用申込書(Joint-Use Application Form)[Excel]
• （様式１−２）確約書(pledge) [Word]
• （様式１−３）放射線業務従事者証明書 [PDF]（No need to submit）
• （様式２）共同利用使用核種変更願 （Application for Change of Radionuclides for Shared Use)[Excel]
• （様式３）共同利用研究従事者変更願(Application for Change of Joint User) [Excel]
• （様式４−１、 ２）共同利用の後始末報告書(Cleanup Report) [Excel]
• （様式４−３）研究経過報告書(Research Progress Report) [Excel]
• （様式５）管理区域一時立入申請書_通年(Temporary entry application form - all year) [Excel]
• （様式７）研究従事者管理区域入退区分変更申請書(Application for Change of Entry/Exit Classification for Researchers) [Excel]
• （共通ID記入方法）(Common ID Filling in Method) [PDF]

Fill in according to the following instructions.

For information on how to enter the Common ID, please refer to here (Common ID Entry Method) .
We will accept it by sending the PDF file by e-mail.

Send to: kanrishitsu(@)ric.u-tokyo.ac.jp

Instructions for filling out the Joint-Use Application Form

1　Research theme and abstract

• Theme: If continuing from the previous year, use the same theme name.
• Summary: If there is not enough space for filling out, make adjustments by making the text smaller.

2　Researcher’s information

• Researcher's name(研究従事者名) : Fill in the research representative's information here.

• Affiliation(所属) : Fill in from undergraduate or graduate school.

• Status(身分) : Select from employee, undergraduate student, graduate student, research student, and others.

• E-mail, extension : Required for emergency contact.

• Individual code(個人コード) : Fill in the code of the radiation worker (if you do not know it, leave it blank).

• Common ID(共通ID) : Fill in the 20-digit number of your staff ID card and student ID card (Common ID Filling in method).(If you leave any blank fields, there may be errors in your registration)

When you register additional researcher, submit new forms that filled in their information.

3　About the type and quantity of RI to be used

•  List all nuclides and their chemical forms that you plan to use and the quantities you expect to use. In the case of activation analysis, etc., fill in the main nuclide to be generated and the expected quantity.
• If you have too many nuclides to fill in, please add them to 共同利用使用核種変更願（Application for Change of Radionuclides for Shared Use) and submit it
• If you do not plan to use  the isotope, draw a diagonal line.

4　Experiments on animals

• If you select “yes(有)”, submit a copy of the approval letter from the Animal Care and Use Committee of your department.

5　Remarks

• If you have any special requirements, write them in the remarks column(備考).