Tracking Number ________________________________

Date _________________

EFFECTIVE: 01/01/2013_v2

RADIOACTIVE US Dangerous Goods

Acceptance Checklist - 2013The continued offering of non-compliant dangerous goods packages may result in the embargo of your dangerous goods shipments by FedEx Express.

Page 1 of 2 This document is an uncontrolled, reference-only, copy.

1. Package is in good condition and free of leakage, odor, or external damage.

2. Package T.I. is within limits. 3. Complies with all applicable government and

FedEx variations. [2.8]4. Destination is serviced (including AK and HI). [SRG]5. If 023 AWB (IP1, IXF, or ATA), correct statement(s)

in the Handling Information box. [8.2.1; 8.2.3]6. Plutonium 239 and 241 (Pu239 and Pu241) will not

be accepted as UN3324, UN3325, UN3326, UN3327, UN3328, UN3329, UN3330, UN3331, or UN3333. [FX-03]

7. Shipper and consignee name and address. For 023 shipments, shipper’s address includes country name. [10.8.3.1; 10.8.3.2 ]

8. Page of Pages. [10.8.3.4]9. Typewritten or computer–generated. Some fields

may be handwritten. [FX-12] 10. Passenger and Cargo Aircraft or Cargo Aircraft

Only limitations correctly indicated. For Passenger and Cargo Aircraft, must be 3.0 TI or less per package AND for use in research or medical diagnosis or treatment. Limitations include additional restrictions of States and Operators. [10.8.3.5; 2.8.2; USG-10]

11. Radioactive correctly indicated. [10.8.3.8]12. “RQ” before or after the basic description.

(e.g.: RQ, UN2915, Radioactive Material, Type A Package, 7; or UN2915, Radioactive Material, Type A Package, 7, RQ. [USG-04]

13. UN number, preceded by the prefix. [10.8.3.9.1, Step 1]

14. Proper shipping name. [10.8.3.9.1, Step 2] 15. Class number 7 [10.8.3.9.1, Step 3]16. Subsidiary risk(s), in parentheses, immediately

following class or division. [10.3.10.1; 10.8.3.9.1 Step 4, A78]

17. Packing Group, corresponding to subsidiary risk. [10.8.3.9.1, Step 5, A78]

18. Name or symbol of radionuclide(s) (e.g., Ir-192, Iridium 192). [10.8.3.9.2, Step 6 (a)]

19. Description of physical and chemical form (e.g., liquid sodium iodide, solid metal, etc.) OR“Special Form” (if not already included in Proper Shipping Name). [10.8.3.9.2, Step 6 (b)]

20. Number of packages and type of packaging (e.g., 1 Type A, 1 IP1, 1 Type B, etc.). [10.8.3.9.2, Step 7]

Y N

Y NY N

Y NN/A Y N

N/A Y N

Section A - On the DeclarationTracking number may be completed by the shipper or the Dangerous Goods Specialist.

Y N

Y NY N

Y N

Y NN/A Y N

Y N

Y NY N

N/A Y N

N/A Y N

Y N

Y N

Y N

21. Activity of radionuclide(s) in Becquerels (e.g., Bq, MBq, GBq, TBq, etc). For Fissile Material, the total weight in grams or kilograms of the fissile material may be shown in place of activity. [10.8.3.9.2, Step 7]

22. Different radionuclides: when not offered as a solution or mixture, the activity of each radionuclide and the words “ALL PACKED IN ONE” and the package type. [10.8.3.9.2, Step 6 and Step 7]

23. “OVERPACK USED” [10.8.3.9.2, Step 8]24. Category of label (e.g., I White, II Yellow, III Yellow).

[10.8.3.9.3, Step 9] 25. II Yellow or III Yellow: TI to one decimal place.

[10.8.3.9.3, Step 9] 26. II Yellow or III Yellow: dimensions of the package (in

metric units). [10.8.3.9.3,Step 9]27. III Yellow: TI does not exceed 10.0 per package.

[Table 10.5.C]28. Special Form international shipment, the Special

Form approval certificate number on the Declaration. [10.8.3.9.4, Step 10]

29. Special Form international shipment, a copy of the approval document(s) in English attached. [10.8.3.9.4, Step 10]

30. Type B package, the design approval number on the Declaration. [10.8.3.9.4, Step 10]

31. Type B package international shipment, a copy of the approval document(s), in English, attached. [10.8.3.9.4, Step 10]

32. Plutonium (Pu) in Type B package: specific approval documents from FedEx Legal/Radiation Physicist attached. [10.8.3.9.4, Step 10, FX-03]

33. 24-hour emergency response telephone number. [USG-12]

34. Name, title, place, date, and shipper’s signature (may be typewritten for US domestic shipments, including US Territories). [10.8.3.13-15]

35. “I declare that all of the applicable air transport requirements have been met” statement. [10.8.3.12.2]

36. Shipper’s signature next to amendments and alterations. [10.8.1.7]

37. Shipper and consignee name and address. [10.7.1.3.1]

38. UN number, preceded by prefix. [10.7.1.3.1] 39. Proper shipping name is marked on the package.

[10.7.1.3.1] 40. “RQ” marked on the package. [USG-04]41. Type A or B packages, Transportation Security Seal

is intact. [10.6.2.4.1.2] 42. Type A, package marked with USA DOT 7A Type A;

or Type A and country of origin, if other than USA. [10.7.1.3.4]

43. Type B, package marked Type B (U or M), and also marked with the design approval number (e.g., USA/9999/B(U)-96 Type B). [10.7.1.3.5;]

Y N

N/A Y N

N/A Y NY N

N/A Y N

N/A Y N

N/A Y N

N/A Y N

N/A Y N

N/A Y N

N/A Y N

N/A Y N

Y N

Y N

Y N

N/A Y N

Y N

Section B - On the Package

Y NY N

N/A Y NN/A Y N

N/A Y N

N/A Y N

N/A Yes No

Directions:Check (ü) N/A, Y or N for each checklist item.• Y: Shipment complies. • N: Shipment does not comply and is rejected. • N/A: Not Applicable

TRACKING NUMBER ________________________________

DATE _________________

EFFECTIVE: 01/01/2013_v2 Page 2 of 2 This document is an uncontrolled, reference-only, copy.

RADIOACTIVE US Dangerous Goods

Acceptance Checklist - 2013The continued offering of non-compliant dangerous goods packages may result in the embargo of your dangerous goods shipments by FedEx Express.

44. Type IP, package marked Type IP, (e.g., Type IP-1, Type IP-2, Type IP-3). [10.7.1.3.3]

45. Gross weight (in metric units) marked when package exceeds 50 kg (110 lb) unless overpacked. [10.7.1.3.1]

46. Two Radioactive labels, correctly completed, on opposite sides. [10.7.3.3; 10.7.4.2.1; 10.7.4.3.1]

47. Two subsidiary risk labels, on the same surfaces of the package near the primary hazard labels. [10.7.3.2; 10.7.4.2.3, A78]

48. Two Cargo Aircraft Only labels, on the same surfaces of the package as the hazard labels.[10.7.4.3.1; 10.7.4.2.4]

49. Labels correctly applied, not obscured, not covering required markings. Irrelevant markings, labels removed or obliterated. [10.7.1.1.1; 10.7.2.1; 10.7.4.1]

50. Package is large enough for all required markings, labels, and documentation; not applied to bottom of package. [FX-11]

51. Fissile Material, specific approval documents from FedEx Legal/Radiation Physicist attached to Declaration.

52. Fissile Excepted: the words “Fissile Excepted” on the Declaration. [10.8.3.9.3, Step 9]

53. Fissile Material: UN2977, UN3324, UN3325, UN3326, UN3327, UN3328, UN3329, UN3330, UN3331, or UN3333, (other than Fissile Excepted): the Criticality Safety Index on the Declaration. [10.8.3.9.3, Step 9]

54. Fissile Material (other than Fissile Excepted): two completed Criticality Safety Index (CSI) labels on opposite sides of the package, in addition to two radioactive category labels. (i.e. I White, II Yellow, or III Yellow). [10.7.4.3.1]

55. Fissile Material package design and country approval numbers on Declaration. Approval documents attached. [10.8.3.9.4, Step 10]

56. Fissile material: the package identification mark contains one of the type codes “AF”,“B (U) F”, “B (M) F”, or “IF” [10.7.1.3.7]

N/A Y NN/A Y N

N/A Y NN/A Y N

Y N

N/A Y N

N/A Y N

Y N

Y N

Section C - Fissile N/A If N/A, skip to Section DThe total weight in grams or kilograms of the fissile material may be shown in place of activity. [10.8.3.9.2, Step 7]

N/A Y N

N/A Y N

N/A Y N

N/A Y N

N/A Y N

N/A Y NN/A Y N

For further assistance, call 1-800-Go-FedEx (1-800-463-3339), then press 81 to be connected to the DG Hotline. EFFECTIVE: 01/01/13 © 2013 FedEx Express - All rights reserved.

Inspected By __________________________________

Emp # _________________

57. “OVERPACK USED” is on the Declaration.

[8.1.6.9.2, Step 7]58. “OVERPACK” is marked on the package if all

markings and labels are not visible. [10.7.1.4.1]59. If multiple overpacks, a unique identification mark

on each overpack (tracking number may be used).[10.7.1.4.2]

60. Cargo Aircraft Only: overpack restrictions met. [5.0.1.5.3.]:

61. Dry ice marking, labeling, and documentation requirements met. [P I 954; 7.1.5.1 (d); 8.2.4]

Y N

Section D - Overpacks N/A If N/A, skip to Section E

Y N

Y N

Y N

Y NSection E - Packages Containing Dry Ice N/A

Shipment does not comply and has been rejected. Due to the regulatory discrepancies indicated, your shipment cannot be transported by FedEx. Returned to shipper using DOT-SP 14691 Shipper Contact Name: _______________________________________ Shipper Contact Phone Number: _______________________________________

Page 1 of 2Dangerous Goods Acceptance ChecklistSample Declaration- 2013

EFFECTIVE: 01/01/2013 This document is an uncontrolled, reference-only, copy

The highlighted numbers correspond to those found on the 2013 FedEx Express Radioactive Acceptance Checklist.

Air Waybill No.

NATURE AND QUANTITY OF DANGEROUS GOODS

FOR RADIOACTIVE MATERIAL SHIPMENT ACCEPTABLE FOR PASSENGER AIRCRAFT, THE SHIPMENT CONTAINS RADIOACTIVE MATERIAL INTENDED FOR USE IN OR INCIDENT TO RESEARCH, MEDICAL DIAGNOSIS, OR TREATMENT. ADR EUROPEAN TRANSPORT STATEMENT: CARRIAGE IN ACCORDANCE WITH 1.1.4.2.1

Emergency Telephone Number

Additional Handling Information

WARNING

I hereby declare that the contents of this consignment are fully andaccurately described above by the proper shipping name, and areclassified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicableInternational and National Governmental Regulations. I declare thatall of the applicable air transport requirements have been met.

Name/Title of Signatory

Place and Date

Signature(see warning above)

Shipment type: (delete non-applicable)

NON-RADIOACTIVE RADIOACTIVEAirport of Destination

Airport of DepartureThis shipment is within thelimitations prescribed for:(delete non-applicable)

TRANSPORT DETAILS

Two completed and signed copies of this Declaration mustbe handed to the operator

Shipper

Consignee

SHIPPER’S DECLARATION FOR DANGEROUS GOODS (Provide at least three copies to the airline.)

Page of Pages

Shipper’s Reference Number(optional)

Failure to comply in all respects with the applicableDangerous Goods Regulations may be in breach ofthe applicable law, subject to legal penalties.

PASSENGERAND CARGOAIRCRAFT

CARGOAIRCRAFTONLY

UN Number, Proper Shipping Name, Class 7, Packing Group (when applicable) //

Name or Symbol of Radionuclide, Physical or Chemical form, Number and Type of packages, Activity //

Category of Label, T.I. (if II or III Yellow), Dimensions (if II or III Yellow) //

Authorizations

Shipper name and address

Consignee name and address

1 187

7

1011

13

18 20 21

33

34

35

24

28, 29, 30, 31, 32

25 26

19

14 15, 16 17

Page 2 of 2Dangerous Goods Acceptance ChecklistSample Package- 2013

EFFECTIVE: 01/01/2013 This document is an uncontrolled, reference-only, copy

The highlighted numbers correspond to those found on the 2013 FedEx Express Radioactive Acceptance Checklist.

7

RADIOACTIVE CONTENTS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

ACTIVITY_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Subsidiary

Risk(if applicable)

#

Handling

Label

(if applicable)

7

RADIOACTIVE CONTENTS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

ACTIVITY_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Subsidiary

Risk(if applicable)

#

Handling

Label

(if applicable)

Security Seal

1, 50

37

3941 38

46, 47, 48, 49

42, 43, 44, 56

46, 47, 48, 49

Need to monitor the status of your shipment? Ask your account executive for information about FedEx Insight®. Want immediate notification of status? Ask about FedEx Priority Alert® service.

FedEx Express offers IATA-endorsed seminars to help you understand dangerous goods regulations and avoid costly fines. Refer to our seminar schedule at http://www.fedex.com/us/hazardous-materials/training/index.html for more information.