Get Form 5 - Nrc - Howard

Filling out the Form 5 - NRC - Howard is essential for recording individual occupational exposure to radiation. This guide provides clear steps to assist users in completing the form accurately and efficiently online.

Follow the steps to complete the Form 5 - NRC - Howard online.

1. Press the ‘Get Form’ button to access the Form 5 - NRC - Howard in your online editor.
2. Type or print the full name of the monitored individual in the designated area, using the format: last name, first name, and middle initial, if applicable.
3. Enter the individual's identification number. Use the 9-digit social security number if available; otherwise, use another official identification number.
4. Select the appropriate code for the type of identification used from the provided options, such as Social Security Number, Passport Number, etc.
5. Indicate the sex of the monitored individual by checking the corresponding box.
6. Fill in the date of birth of the monitored individual in the format MM/DD/YYYY.
7. Specify the monitoring period for which the report is being filed, using the format MM/DD/YYYY - MM/DD/YYYY.
8. Enter the name of the licensee in the provided field.
9. Input the NRC license number or numbers.
10. In section 9A, mark ‘Record’, ‘Estimate’, or ‘No Record’ based on the dose data status.
11. In section 9B, check ‘Routine’ or ‘PSE’ based on the type of monitoring results.
12. For field 10A, enter the symbol for each radionuclide recorded for the individual using the specified format.
13. In field 10B, state the lung clearance class based on the guidelines.
14. Specify the mode of intake in field 10C with the designated letters.
15. Fill in the intake of each radionuclide in field 10D.
16. Complete fields 11 through 16 with the respective dose information as measured.
17. In field 19, include any additional comments relevant to the report.
18. Provide the signature of the person designated to represent the licensee.
19. Finally, enter the date the form was prepared.
20. Once all fields are completed, save your changes and choose to download, print, or share the completed form as necessary.

Complete your Form 5 - NRC - Howard online to ensure compliance with radiation exposure reporting.