Radiation Training & Experience History & Personal Dosimetry

Name

Radiation Use Information

Check Applicable Radiation Safety Training Registering For:

Have you been enrolled in a personnel monitoring (dosimetry badge) program within the last calendar year OR are you currently enrolled in a personnel monitoring (dosimetry badge) program?

**Provide a copy of your most recent dosimetry results or estimate. If this is not available, your annual limit will be reduced by 1.25 REM for each calendar quarter for which results are not available.**

Size of extremity monitor (ring badge):