Get Claim Activity Log Form

Filling out the Claim Activity Log Form online is a straightforward process that ensures your activities are documented accurately. This guide provides detailed, step-by-step instructions tailored to help users effectively complete each section of the form.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin with the CNSC Licence Number. Enter the number assigned to your license in the designated field.
3. Indicate the period for which the Annual Compliance Report is being completed. Fill in the end date using the format yyyy/mm/dd.
4. Provide the licensee information by entering the name, head office address, city, province/state, country, and postal/zip code.
5. Complete the section for the Radiation Safety Officer or License Contact Person. Include their name, mailing address (if different), city, province/state, country, postal/zip code, telephone, facsimile, and email address.
6. If applicable, fill out the details for an Alternate Contact Person. Include their name, telephone, facsimile, and email address.
7. For the Financial Contact Person, provide their name, position title, and address details as with the previous sections.
8. List all locations where licensed activities were conducted for over 90 consecutive days during the reporting period. For multiple locations, continue using the prescribed format.
9. Detail the inventory of radiation devices and sealed sources, including information about authorized location, reference date, nominal activity, nuclear substance, and serial numbers.
10. In the Radiation Protection Program section, describe any changes made to policies or procedures on a separate sheet.
11. List any incidents or unusual occurrences reported during the period. This includes the date of the event, type of event, and relevant nuclear substances.
12. Summarize the annual effective whole body radiation doses received by Nuclear Energy Workers and non-NEWs, categorizing them appropriately.
13. Complete the Declaration by the Radiation Safety Officer or Licence Contact Person, ensuring to provide their name, title, and the certification date.
14. Finally, review the completed form for accuracy, then save changes, download, print, or share as needed.

Take action now and complete your documents online for a streamlined process.