Exposure B SUNY Erie Community College – City Campus Division of Health Sciences Radiation Therapy Technology Student Radiation Exposure Form
The Global Dosimetry Services Report for the monitoring period from _________20___ through _________20 ___ has been verified that student ______________________________ received an exposure of ____________________ for that quarter, exceeding the established threshold dose of 100 mrem/quarter. Clinical affiliate sites visited during that time frame, RSO, any known exposure circumstances:
1.________________________________________
RSO__________________________
______________________________________________________________________________
2._________________________________________
RSO__________________________
______________________________________________________________________________
3._________________________________________
RSO__________________________
______________________________________________________________________________
An inquiry will be made with each of the above Radiation Safety Officers. Records of students from the previous rotations of these clinical sites will be reviewed.
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