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University of Toronto Radiation Protection Services Application for TLD Radiation Monitoring Service Application must be authorized by Permit Holder AND Badge Coordinator Note Only users of strong beta like P-32 and gamma emitters like I-125 need a TLD. Radiation emitted by H-3 C-14 and S-35 cannot be detected by the TLD The following information is required for CNSC licensing purposes. Please complete the form and submit to Radiation Protection Services Fax 416-971-1361. Surname Full Given Name Work Phone E-mail Position Sex Male Date of Birth mm/dd/yy Country and Province of Birth Social Insurance Number Personnel / Student Have you worn a TLD previously Y N Female If so where If Term or Summer Employee specify termination date mm/dd/yy If no date is specified badges will be provided continuously until Radiation Protection Service is notified otherwise. University of Toronto Radiation Protection Services Application for TLD Radiation Monitoring Service Application must be authorized by Permit Holder AND Badge Coordinator Note Only users of strong beta like P-32 and gamma emitters like I-125 need a TLD. Radiation emitted by H-3 C-14 and S-35 cannot be detected by the TLD The following information is required for CNSC licensing purposes. Please complete the form and submit to Radiation Protection Services Fax 416-971-1361. Surname Full Given Name Work Phone E-mail Position Sex Male Date of Birth mm/dd/yy Country and Province of Birth Social Insurance Number Personnel / Student Have you worn a TLD previously Y N Female If so where If Term or Summer Employee specify termination date mm/dd/yy If no date is specified badges will be provided continuously until Radiation Protection Service is notified otherwise. Type of Thermo-Luminescent Dosimeter TLD Required Whole Body/Skin Extremity Ring Ring Size S using more than 1 mCi of P-32 Tc-99m K-42 etc requires TLD ring M L Neutron for users of neutron sources only Cost Centre Central Fund Centre Department/Division GLOBAL Account/Location Number Badge Co-ordinator Please print First name Last name Phone Number Permit Number Date Permit Holder Signature Required For Radiation Protection Service Use Only Training requirements fulfilled Course Series Code Number Badge Number. University of Toronto Radiation Protection Services Application for TLD Radiation Monitoring Service Application must be authorized by Permit Holder AND Badge Coordinator Note Only users of strong beta like P-32 and gamma emitters like I-125 need a TLD. Radiation emitted by H-3 C-14 and S-35 cannot be detected by the TLD The following information is required for CNSC licensing purposes. Radiation emitted by H-3 C-14 and S-35 cannot be detected by the TLD The following information is required for CNSC licensing purposes. Please complete the form and submit to Radiation Protection Services Fax 416-971-1361. Surname Full Given Name Work Phone E-mail Position Sex Male Date of Birth mm/dd/yy Country and Province of Birth Social Insurance Number Personnel / Student Have you worn a TLD previously Y N Female If so where If Term or Summer Employee specify termination date mm/dd/yy If no date is specified badges will be provided continuously until Radiation Protection Service is notified otherwise.

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