NMIS Radiation Dosimeter Monitoring Form

Report Information
Student Name * Required
Student Email * Required
Today's Date * Required
MM slash DD slash YYYY
Report for Radiation Dosimeter Monitoring Period (Month) * Required
Report for Radiation Dosimeter Monitoring Period (Year) * Required
Radiation Information
Ring Finger Rad. Type/Rad. Quality * Required
Ring Finger Dose Equivalent (mrem) - Shallow (SDE) * Required
Use the drop downs below to report any others besides the ring finger.
Use #1 * Required
Use #1 Rad. Type/Rad. Quality * Required
Use #1 Dose Equivalent (mrem) - Deep (DDE) * Required
Use #1 Dose Equivalent (mrem) - Eye (LDE) * Required
Use #1 Dose Equivalent (mrem) - Shallow (SDE) * Required
Use #2 * Required
Use #2 Rad. Type/Rad. Quality * Required
Use #2 Dose Equivalent (mrem) - Deep (DDE) * Required
Use #2 Dose Equivalent (mrem) - Eye (LDE) * Required
Use #2 Dose Equivalent (mrem) - Shallow (SDE) * Required
Use #3 * Required
Use #3 Rad. Type/Rad. Quality * Required
Use #3 Dose Equivalent (mrem) - Deep (DDE) * Required
Use #3 Dose Equivalent (mrem) - Eye (LDE) * Required
Use #3 Dose Equivalent (mrem) - Shallow (SDE) * Required
Comments
Click the "Yes" button below to signify your acknowledgement and understanding of the radiation dosimetry report for the month specified above. * Required
- Yes

Report Information