Saint Louis University
Radiation Safety
ASSIGNMENT FORM FOR SPARE BADGES
R
EPORT DOSIMETERS ISSUED BY BADGE COORDINATOR PRIOR TO RETURN OF BADGES
Please Return To: Lance Peters in the Office of Environmental Health & Safety
1402 S. Grand Blvd., Caroline 305 St. Louis, MO 63104
email: petersl2@slu.edu Fax: (314) 977-5560
1. To Assign Dose to a Participant:
a) From printed data on spare dosimeter, complete
columns 1, 4 & 7. (Instructions in section 2.)
b) Enter the wear period begin and end date in columns
10 &11.
c) Complete columns 12 through 15. with participant
information.
2. To Complete Spare Badge Information:
a) Badge i
dentification information is on the back of the badge.
b) The Badge Serial number is found just above the bar code.
c) The Date is on the first line on the back of the badge.
d) The three Capital letters on the second line indicate the
series code.
SPARE BADGE INFORMATION PARTICIPANT
TYPE
DATA TO BE REPORTED PERMANENT REPORTING DATA
Badge
Serial
#
Account
#
S
p
a
r
e
#
Date on
Badge
R
e
g
u
l
a
r
N
e
w
*One
Time
Us
er Do
Not
Carry
Totals
Account
#
Participant
#
Series
Code
F
r
e
q
B
egin
Wear
Date
End
Wear
Date
Participant Name
Social
Security
Sex
Birth
Date
(1) (2) (3) (4)
Cols 1-4
(5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
Waist,
Collar,
or
Whole
Body
