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Radiation Request Forms
Radiation Request Forms
Radiation Request FormsRadiation Request Forms

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    STERIS AST Radiation Request Form

    Radiation Request Form

    This Form must be completed by Customer prior to quote and processing

    1Contact Details
    2Recipient of Transmittal Information
    3Shipping Information
    4Type of Testing
    5Product Information
    • Select a Radiation Technology Center from the following:

    • STEP 1: Contact Details

      Fill in the fields below. Once you are finished click the blue next section button at the bottom of the page to go to the next section
    • Product cannot be processed without a P.O. #; if using a credit card type "credit card" in the P.O. # box
    • An Email address is required for quote
    • Add any additional email addresses that should be cc'd into the quote here

    • Product Received From (Originator):

    • Product Belongs to (Customer):

    • Pick whether the Customer contact details are the same as Originator, Billing or Shipping. If none of the above, select "None of the Above" and you will be prompted to fill in the correct details

    • Send Invoice to (Party to be billed):

    • Pick whether the Invoice contact details are the same as Originator, Customer or Shipping. If none of the above, select "None of the Above" and you will be prompted to fill in the correct details

    • Ship Irradiated Product to:

    • Pick whether the Shipping contact details are the same as Originator, Customer or Billing. If none of the above, select "None of the Above" and you will be prompted to fill in the correct details

    • STEP 2: Recipient of Transmittal Information

      Fill in the fields below. Once you are finished click the blue next section button at the bottom of the page to go to the next section
    • If needed

    • STEP 3: Shipping Information

      Fill in the fields below. Once you are finished click the blue next section button at the bottom of the page to go to the next section
    • Once you have made your selection you will be prompted to enter the appropriate options for each Shipping type
    • For international shipping please provide the Commercial Invoice
    • For international shipping please provide the Commercial Invoice
    • If the Carrier Account # is not provided or the Account Number is Invalid, you will be billed shipping charges plus 30%
    • If the Carrier Account # is not provided or the Account Number is Invalid, you will be billed shipping charges plus 30%
    • If the Carrier Account # is not provided or the Account Number is Invalid, you will be billed shipping charges plus 30%

    • STEP 4: Test Details

      Fill in the fields below. Once you are finished click the blue next section button at the bottom of the page to go to the next section
    • Please specify
    • Is this an existing process described under protocol?
    • Please provide Protocol Number
    • For product of this nature, we will require further information. Do NOT send the specified product to the STERIS AST processing site until you have received a call-back from the site manager and have agreed this is possible.
    • Please specify
    • Please Specify
    • Submittal contains samples classified as requiring special packaging, handling, or storage per the United Nations Recommendations on the Transport of Dangerous Goods, International Air Transport Association or any other regulatory oversight for the possession, handling, accountability or shipping of the samples.
    • Please attach any appropriate SDS' to the outside of the box upon shipping as well as uploading onto the portal.
      Max. file size: 32 MB.
    • It is the Customers' responsibility to inform STERIS of any known Registration/Certification/Licence Requirements. Only those stated by the Customer will be reviewed by STERIS prior to product processing.

    • STEP 5: Product Information

      All fields are required. Information MUST be present for both pricing and processing, if dimensions, weight, etc. are unavailable/unknown (e.g. product sent directly from lab) please indicate "price upon arrival" in special instructions.

      This is the final section. Once you are ready hit the green submit button at the bottom of the form and your request will be sent for processing

    • Does the material contain any metals?
    • Products that contain metals must be assessed for potential for induced radioactivity (activation).

    • Instructions for Product Information Table

      1. Please list quantity of Cartons for each set of Dimensions and/or Dose Range. If control samples are routed and are not to be irradiated, itemize the carton(s) and enter 0.0 in both boxes for the Dose Range. In the Description enter "Control Samples- Do Not Irradiate"
      2. Please list as carton for processing, prior to bundle or repack, not including shipper)
      3. Please round to one decimal place
        • If the interior product configuration allows, and product is to be irradiated at ambient conditions, an internal dosimeter may be placed and removed in the center of the processing carton. The product may be repacked, bundled, or the original shipper cut down for processing efficiency. Unless otherwise requested, all shipping cartons will be opened upon receipt.
        • Submitted cartons will be marked/labeled w/tracking numbers, product lines, irradiation status, and/or tape for dosimeter mappings. If your carton should not receive any markings, indicate in the Special Instructions “Do not mark product cartons”.
    • To add a new row, click the plus sign at the end of the first row. To remove a row once added, click the minus sign at the end of the row you wish to remove. If processing within Europe dimensions should be in mm and weight in kgs. If processing within the Americas dimensions should be in inches and weight in lbs.
      # of CartonsDimensions (L x W x H)WeightDose Range Min (kGy)Dose Range Max (kGy)Lot NumberProduct CodeDescription 

    • If product is labeled sterile and a CURRENT Non-Sterile Agreement has not been completed, the facility will be sending an Agreement for completion, as required per 21CFR 801.150 and 21 CFR 201.150 prior to shipment

    • Add special instructions below.

    • Check all options you would like to be quoted for

      Note: Processing times are in business days, excluding weekends, holidays, and day of shipment

      Note: Some quantities and/or high Dose Requirements may not be available for Priority or Same Day

    • Requires 24-48 hours advance notice
    • PROC-00481 Attachment C Rev 10 Effective Date: 05/11/2016
    • This field is for validation purposes and should be left unchanged.
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    5960 Heisley Road | Mentor, OH 44060 USA

    877.783.7479

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    STERIS AST Radiation Technology Center

    (847) 247-4782

    RadiationTechTeam@steris.com

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