Get Dosimetrist At Texas Tech Form

Completing the Dosimetrist At Texas Tech Form is an important step for individuals seeking personal dosimetry services. This guide will assist you in filling out the form online, ensuring that all necessary information is accurately provided.

Follow the steps to successfully complete the online form.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by entering your full name. Fill in your last name, first name, and middle name or maiden name as applicable. Ensure clarity in your typing or writing.
3. Indicate your gender by selecting either 'Male' or 'Female'.
4. Enter your Employee R Number, if applicable, and your date of birth in the specified format.
5. Fill in your department and the name of your Principal Investigator.
6. Provide the laboratory location along with the laboratory phone number.
7. Answer whether you have previously worked at TTUHSC by selecting 'Yes' or 'No'. If 'Yes', complete the additional fields regarding your previous employment including the dates of employment and department.
8. Indicate if you have prior training or experience in radiation safety by selecting 'Yes' or 'No'. If 'Yes', be sure to attach the documentation or certification as required.
9. Indicate if you have ever been enrolled in a radiation dosimetry or monitoring program by selecting 'Yes' or 'No'. If 'Yes', complete the Occupational Exposure History information, listing all relevant employers, their addresses, and the dates of employment.
10. Provide your forwarding address for any future reports of radiation exposure, including street address, city, state, and zip code.
11. Review the statement granting permission for Texas Tech University Health Sciences Center to obtain your previous radiation exposure history from listed employers.
12. Sign and date the form to confirm that the information you provided is accurate.
13. Upon completion, you can save the changes, download, print, or share the form as needed.

Complete your Dosimetrist At Texas Tech Form online today to ensure you receive the necessary dosimetry services.