Fillable UNIVERSITY RADIATION SAFETY OFFICE LOST DOSIMETER REPORT (Wright State University)

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UNIVERSITY RADIATION SAFETY OFFICE LOST DOSIMETER REPORT (Wright State University)

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Version2015.1 Revised:25Feb2015 UniversityRadiaonSafetyOffice
UNIVERSITY RADIATION SAFETY OFFICE
LOST DOSIMETER REPORT
Name:
U.ID#:
Date of Birth:
Type of Dosimeter:
Period for which dosimeter was lost:
Circumstances surrounding loss:
Describe your exposure during this period:
List people who perform similar tasks:
Signature/Date
For Radiation Safety Officer Review
Comments:
Estimated Exposure:
Radiation Safety Officer Signature/Date:
Cc:
Similar to previous dosimetry periods.
Did not encounter any radiation sources.
Probably higher than previous dosimetry periods. Describe:
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UNIVERSITY RADIATION SAFETY OFFICE LOST DOSIMETER REPORT (Wright State University)

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Completed 16 December 2020

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