Get the free Lost / Damaged Dosimeter Report - stanford

This form is used to report a lost or damaged dosimeter, allowing the estimation of radiation dose based on usual usage and activities during the monitoring period.

How to fill out lost damaged dosimeter report

How to fill out Lost / Damaged Dosimeter Report

1. Obtain a Lost / Damaged Dosimeter Report form from your authorized safety officer or online portal.
2. Clearly write your personal information at the top of the form, including your name, department, and contact details.
3. Specify the date the dosimeter was lost or damaged.
4. Describe the circumstances of the loss or damage, including location and any events that occurred.
5. Indicate the type of dosimeter (e.g., thermoluminescent dosimeter, film badge) on the form.
6. Include the serial number of the dosimeter if available.
7. Sign and date the report at the bottom.
8. Submit the completed form to your supervisor or the designated safety officer for processing.

Who needs Lost / Damaged Dosimeter Report?

1. Employees who have lost or damaged their radiation dosimeter.
2. Supervisors or managers responsible for tracking dosimeter assignments.
3. Health and safety officers ensuring compliance with radiation safety protocols.
4. Accredited laboratories that require recording of dosimeter incidents.

People Also Ask about

What is a dosimeter report?

The Radiation Dosimetry Report provides dose of record information for participants wearing dosimeters and is generated when dosimeters are returned to LANDAUER for analysis. Reports can be retrieved electronically and provide deep dose equivalent, lens dose equivalent and shallow dose equivalent data.

How often should dosimeters be replaced?

(3) Film badges must be replaced at least monthly and all other personnel dosimeters that require replacement must be replaced at least quarterly. All personnel dosimeters must be evaluated at least quarterly or promptly after replacement, whichever is more frequent.

Are dosimeters mandatory?

Not every healthcare worker requires a dosimetry badge, but those with significant radiation exposure, such as radiologic or nuclear medicine technologists and interventional physicians, must be monitored to ensure safety and compliance.

How often should an employee receive a new dosimeter badge?

Who Should Wear X-ray Badges? In general, dosimeters are required for anyone who could receive up to 10% of the annual radiation exposure limit or as specified by the conditions for monitoring personnel within your state regulations.

What happens if I lose my dosimeter?

Notify REHS if your dosimeter is lost or damaged. REHS can quickly issue a replacement dosimeter. Store your dosimeter at a safe distance from a radiation source where radiation levels are below background, and either in the lab or a designated area when not in use.

What happens if you lose your dosimeter?

Lost or damaged dosimeter: If your dosimeter is damaged or lost, promptly contact the badge coordinator or the Radiation Safety Office so that a replacement dosimeter can be issued. Pregnancy and fetal dosimeters: Declared pregnant workers may be issued a designated fetal dosimeter.

How long are dosimeters good for?

While the dosimeter can last up to one year, companies will conduct dosimetry exchanges more frequently (monthly, bi-monthly, quarterly). To prolong the life of your dosimeter, it should be stored in a secure and environmentally stable area of the workplace with its associated control dosimeter(s).

For pdfFiller’s FAQs

What is Lost / Damaged Dosimeter Report?

The Lost / Damaged Dosimeter Report is a formal document used to report and track dosimeters that are either lost or damaged, ensuring proper records are maintained for safety and regulatory compliance.

Who is required to file Lost / Damaged Dosimeter Report?

Any individual who is issued a dosimeter, including employees and contractors working in environments where radiation exposure is monitored, is required to file a Lost / Damaged Dosimeter Report if their dosimeter is lost or damaged.

How to fill out Lost / Damaged Dosimeter Report?

To fill out the Lost / Damaged Dosimeter Report, you should provide your personal information, details about the dosimeter (such as serial number and type), the date of loss or damage, a description of the incident, and any other required signatures or authorizations.

What is the purpose of Lost / Damaged Dosimeter Report?

The purpose of the Lost / Damaged Dosimeter Report is to document incidents involving dosimeters for accountability, to ensure that radiation exposure can still be monitored accurately, and to facilitate the replacement of lost or damaged dosimeters.

What information must be reported on Lost / Damaged Dosimeter Report?

The report must include the individual's name, employee or contractor number, dosimeter serial number, the type of dosimeter, a description of the loss or damage incident, the date it occurred, and any relevant signatures or additional notes.