Application of working in Radiation Areas
* Please write in block letters.
DATE ______________________
To RCNP Director
Institution : __________________________________________________
Name of Approver : ___________________________________________________
Position of Approver : ___________________________________________________
Name of Radiation Safety Officer : ___________________________________________________
e-mail address : ___________________________________________________
The letter is to confirm that ( Mr./Ms.) ______________________________ can work as Visitor Users in Radiation Controlled Areas of RCNP Facilities.
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Full Name |
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M / F |
Date of Birth |
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Institute position |
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Duration of Working RCNP |
from ( within 1 fiscal year ending 31 March) |
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Monitor the Radiation |
Yes / No |
Type of Radiation Monitoring |
for example, filmbadge, TLD |
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Dose exposed during last year |
effective dose (1cm)
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skin (70micro m)
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Medical Examination for Radiation Exposure |
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Done : DATE1) |
Not yet |
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Educated about Radiation Safety |
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Yes : DATE |
Not yet |
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1) A Copy of the Medical Certificate or medical surveillance to work at radiation zone within this 1 year is required.