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This document provides guidance on how to utilize NRC Form 4 for listing periods of exposure at different licensed facilities while working for an employer that is not a licensee, specifically regarding
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How to fill out Guidance on the Use of NRC Form 4

01
Read the instructions provided at the beginning of the NRC Form 4 carefully.
02
Gather all necessary personal and organizational information required for the form.
03
Complete Section 1 by entering your name, address, and contact information.
04
Fill out Section 2 with details about your employer, if applicable.
05
Complete Section 3 by selecting the type of license or authorization that you are applying for.
06
In Section 4, provide information about the types of activities you will be conducting.
07
Complete Section 5 by listing any relevant training or qualifications.
08
Review all sections to ensure accuracy and completeness before submitting the form.
09
Sign and date the form as required in Section 6.

Who needs Guidance on the Use of NRC Form 4?

01
Individuals applying for licenses related to the use of radioactive materials.
02
Organizations involved in activities that require NRC licensing.
03
Personnel responsible for submitting applications on behalf of their employers.
04
Regulatory compliance officers and safety professionals in nuclear facilities.
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Guidance on the Use of NRC Form 4 provides instructions on how to accurately complete and submit this specific form required by the Nuclear Regulatory Commission (NRC). It outlines necessary details regarding the reporting of individual radiation exposure.
Individuals who are exposed to ionizing radiation in excess of certain limits as part of their employment in operations regulated by the NRC are required to file NRC Form 4.
To fill out Guidance on the Use of NRC Form 4, individuals must provide their personal information, details of radiation exposure, and any necessary supporting documentation as specified in the instructions provided by the NRC.
The purpose of Guidance on the Use of NRC Form 4 is to ensure that employees with potential radiation exposure report their exposure accurately to comply with regulatory requirements and protect their health.
The information that must be reported includes the individual's identifying details, the type and amount of radiation exposure received, the date of exposure, and any other relevant exposure history.
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