STERIS AST Radiation Request Form

Radiation Request Form

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

"*" indicates required fields

1Contact Details

2Recipient of Transmittal Information

3Shipping Information

4Type of Testing

5Product Information

Comments

This field is for validation purposes and should be left unchanged.

Radiation Center*

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

PO #

Product cannot be processed without a P.O. #; if using a credit card type "credit card" in the P.O. # box

PO Upload

Max. file size: 32 MB.

Email*

An Email address is required for quote

Enter Email Confirm Email

Additional Emails

Add any additional email addresses that should be cc'd into the quote here

Product Received From (Originator):

Originator Company Name*

Originator Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Originator Contact Name*

Originator Email*

Originator Phone*

Product Belongs to (Customer):

Customer Contact Details*

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

Same as Originator

Same as Party to be billed

Same as Shipping

None of the Above

Customer Company Name

Customer Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Customer Contact Name*

Customer Email*

Customer Phone*

Send Invoice to (Party to be billed):

Invoice Contact Details*

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

Same as Originator

Customer

Same as Shipping

None of the Above

Invoice Contact Details*

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

Same as Originator

Customer

Same as Shipping

Address Listed on PO

None of the Above

Customer Name

Invoice Company Name

Invoice Address and Company Name*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Invoice Contact Name*

Invoice Email*

Invoice Phone*

Ship Irradiated Product to:

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

Same as Originator

Same as Customer

Same as Party to be Billed

None of the Above

Ship to Company Name

NOTE: PO Box cannot be used as a Shipping Address

Shipping Address and Company Name*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Contact Name*

Shipping Email*

Shipping Phone*

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

Original Certificate of Processing*

Original of Certificate of Processing, Dosimetry Record and Radiation Request Form (via email)*

Copy of Certificate of Processing

If needed

Dosimetry Record?*

Yes

Radiation Request Form returned to*

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

Ship Via*

Expected delivery date at STERIS RTC:

Select courier*

Once you have made your selection you will be prompted to enter the appropriate options for each Shipping type

UPS Shipping*

Next Day Air

2 Day Air

Ground

Early A.M.

Saturday Delivery

FED EX Shipping*

Priority Overnight

Standard Overnight

2 Day

First Overnight

Saturday Delivery

International UPS Shipping

For international shipping please provide the Commercial Invoice

Express

Standard

Saturday Delivery

International FED EX Shipping*

For international shipping please provide the Commercial Invoice

Priority

Economy

Saturday Delivery

UPS Account #

If the Carrier Account # is not provided or the Account Number is Invalid, you will be billed shipping charges plus 30%

Fed Ex Account #

If the Carrier Account # is not provided or the Account Number is Invalid, you will be billed shipping charges plus 30%

Other Account #

If the Carrier Account # is not provided or the Account Number is Invalid, you will be billed shipping charges plus 30%

Carrier

Service

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

Type of Testing*

Dose Verification (Dose Audit/Dose Establishment)

Max Dose

Product Development

Materials Testing

Contract Sterilization for Release to Market

Other/R&D

Type of Testing*

Dose Verification (Dose Audit/Dose Establishment)

Max Dose

Product Development

Materials Testing

Contact Sterilization for Release to Market

Dose Mapping

Dose Mapping (routine product will be sold to market after processing)

Other/R&D

Type of Testing*

Dose Verification (Dose Audit/Dose Establishment)

Max Dose

Product Development

Materials Testing

Contract Sterilization for Release to Market

X-ray Activation Test

Other/R&D

Type of Testing*

Dose Verification (Dose Audit/Dose Establishment)

Max Dose

Product Development

Contact Sterilization for Release to Market

Materials Testing

X-ray Activation Test

Dose Mapping

Dose Mapping (routine product will be sold to market after processing)

Other/R&D

Number of units to be sent*

Other/R&D description*

Please specify

STERIS Protocol*

Is this an existing STERIS process described under protocol?

STERIS Protocol Number*

Please provide Protocol Number

Product Classification*

Medical Device

Pharmaceutical

Active Pharmaceutical Ingredient (API)

Controlled Drug

Tissue

Soil

Food

Herbs & Spices

Other

Product Classification*

Medical Device

Pharmaceutical

Active Pharmaceutical Ingredient (API)

Controlled Drug

Tissue

Soil

Food

Herbs & Spices

Raw materials for pharmaceutical use

Other

QP Release required*

Yes

Tissue*

Human

Animal

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.

Human Consumption*

Human Consumption

Non-human Consumption

Other Product Specification*

Please specify

Certification/License Requirements*

ISO11137

GMP Human

GMP Veterinary

FDA

Other (please specify)

Certification/License Requirements*

ISO11137

FDA

Other (please specify)

FDA*

Medical Device

Drug

Generic Drug

Tissue

Blood

Food

Other*

Please Specify

Hazardous Material?*

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.

Safety Data Sheet

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

Internal Dosimeter*

Some package configurations may require the placement of an internal dosimeter to monitor the minimum dose location. I hereby give approval to place internal dosimeters as needed. If product is packaged in a manner that will not allow the placement and retrieval (post-irradiation) of an internal dosimeter, I give approval to repackage the contents or open any secondary packaging to accommodate this placement as needed, if it is physically possible.

I do not approve the placement of an internal dosimeter; I acknowledge that my product will be monitored only with externally placed dosimetry, which may not capture minimum imparted dose delivery zones on the below submitted product.

Process Packaging*

Process outside of carton

Process in carton

Size of single pieces

Instructions for Product Information Table

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"

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/ units 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”.

Instructions for Product Information Table

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"
Please list as carton for processing, prior to bundlebundling or repack, not including shipper

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”.

Instructions for Product Information Table

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"
Provide a dose range is +/- 10% of target. A lower dose range requires STERIS consent

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”.

Instructions for Product Information Table

Please list the 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".
Please list as carton for processing, prior to bundle or repack, not including shipper.
Please round to one decimal place. Dose range is target dose +/- 10% or wider A tighter dose range requires STERIS consent. The achievable dose range depends on the size and weight of the cartons.
- 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"”".

Table Instructions Confirmation*

I confirm I have read the Table Instructions

Product Information*

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 Shipping Cartons

Dimensions (L" x W" x H")

Number of Pieces

Weight

Dose Range Min (kGy)

Dose Range Max (kGy)

Lot Number

Product Code

Description

Product Information*

# of Cartons

Dimensions (L" x W" x H")

Weight

Dose Range Min (kGy)

Dose Range Max (kGy)

Lot Number

Product Code

Description

Product Information*

# of Cartons

Dimensions (L x W x H)

Weight

Dose Range Min (kGy)

Dose Range Max (kGy)

Lot Number

Product Code

HS Code

Country of Origin

Value of the Goods

Product Information - System of Measurements*

Product Information - Please provide product dimensions, weight, and drawing or picture

Max. file size: 32 MB.

EBeam Parametric Release request

EBeam Parametric Release requested (release without dosimeter)

Description

Customs information for shipment within the EU*

EU intraCommunity VAT

Customs Nomenclature

Not Applicable

EU intraCommunity VAT

Customs Nomenclature

Customer Instructions

Dry Ice

Refrigerate

Freezer

Email notification of tracking number

Temperature Logger enclosed

Non-Sterile Product Labeled Sterile

Customer Instructions

Dry Ice

Bundle, If possible

Email notification of receipt

Refrigerate - Uncontrolled Range

Repack

Email notification of tracking number

Freezer - Uncontrolled Range

Temperature Logger enclosed

Non-Sterile Product Labeled Sterile

Customer Instructions

Dry Ice

Bundle, If possible

Refrigerate - Uncontrolled Range

Repack

Freezer - Uncontrolled Range

Temperature Logger enclosed

Non-Sterile Product Labeled Sterile

Cold Chain Language

Receipt*

Storage / pre*

Processing*

Storage post*

Shipping*

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

Special Instructions

Add special instructions below.

Special Instructions - Supporting Document(s)

Drop files here or

Max. file size: 32 MB.

Processing Information*

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

Standard: up to 10 working days

Priority: up to 3 working days

Express: 1 day / 24 hours (requires 24-48 hours advance notice and confirmation)

Processing Information*

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

Mapping Routine: up to 15 working days

Mapping Priority: up to 8 working days

Standard: up to 10 working days

Priority: up to 3 working days

Express: up to 1 day / 24 hours (requires 24-48 hours advance notice and confirmation)

Processing Information*

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 Routine, Priority or Same Day

Express: < 1 working day from time of product receipt

Priority: < 3 working days from time of product receipt

Standard: < 10 working days from time of product receipt

Extended: <= 14 working days from time of product receipt

Requires 24-48 hours advance notice

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

Q08-FR-001976 Effective Date: 01/02/2026