Radiology Refresher MRI Safety Course

This purpose of this form is to make a MRI Safety presentation available to you. You are to view this presentation by downloading it from this page and viewing it. We are collecting information on the individuals filling out this form.

If you have any questions regarding this form, please contact CAMRIS.

Thank you!

Today's Date

M-D-Y

Last Name

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First Name

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Department

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What position do you hold?

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E-mail

*Must be a UPHS or UPENN account*

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Do you know who your lab manager or supervisor is?

Yes

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You cannot take this refresher course until you provide your Lab Manager or Supervisor's name.

Lab Manager Last name

Lab Manager First name

What is your Radiology affiliation ?

Core

Lab

Clinical division

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Please select your lab

Please select the imaging core you work in?

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Please review the Power Point presentation about MRI Safety. Answer the questions that follow when finished. Sign the areas that request your signature ( use your mouse or pad (if you have one))

Attachment:MRsafety presentation (1).ppt

Have you reviewed the presentation?

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Yes

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Did you understand the information contained in the presentation?

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Yes

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You have not met the requirements for completing the refresher course. You should forward the questions you have to your Lab Manager or Supervisor immediately, and have them contact UPENN Radiology Research. Until the questions are resolved you are not allowed to enter any MRI in UPENN Radiology Research. Even if you submit this form, you still will not be authorized until successful completion of this refresher course takes place.

By answering yes to the above questions I acknowledge that I have completed the refresher course on MRI safety. I understand that the MR SAFETY issues presented are of paramount importance to the safety of myself and others.

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