IOWA DEPARTMENT OF TRANSPORTATION

OFFICE OF MATERIALS

 

NUCLEAR TLD BADGE CERTIFICATION

 

 

I HEREBY CERTIFY THE FOLLOWING:

 

1.     The operator(s) has attended the training course in nuclear testing conducted by the Central Laboratory.

 

2.     All safety practices outlined in Materials IM 206 have been followed.

 

3.     The following individual(s) was wearing a nuclear exposure badge on his/her front waist, while operating nuclear testing equipment, and that the exposure as determined on the enclosed badges should be indicative of radiation received for the appropriate time period.

 

EXPOSURE PERIOD/DATE:             From: ____________________ To:                       

 

                                                                                                                                 APPROX.TIME

NAME                                                 TLD BADGE NO.             GAUGE NO.        WITH GAUGE

 

__________________________        _________________        ___________                 

 

__________________________        _________________        ___________                 

 

__________________________        _________________        ___________                 

 

__________________________        _________________        ___________                 

 

__________________________        _________________        ___________                 

 

__________________________        _________________        ___________                 

 

__________________________        _________________        ___________                 

 

 

COMMENTS:

 

 

            The above information, to the best of my knowledge, is complete and accurate.

 

                                                                                                                                           

                                                           Person in Charge                              Date

 

 

 

cc:    Office of Materials Laboratory

         District File