Get Umhhc - New Series Request Form - Oseh - University Of Michigan

The UMHHC - New Series Request Form is essential for establishing a dosimetry series at the University of Michigan. This guide provides clear, step-by-step instructions for filling out the form online, ensuring that users can complete the process efficiently and accurately.

Follow the steps to fill out the form seamlessly.

1. Click ‘Get Form’ button to obtain and access the form in your preferred online environment.
2. In Section 1, enter the information for the series: include the department name, division, and job title for the dosimetry series you are creating. It’s important to note that a separate series must be created for each job title or position.
3. Indicate the type of exposure for the individuals listed, selecting from options such as radiation producing machines, radioactive materials, or both. Check all that apply.
4. Specify the radiation producing equipment the individuals will be using, if applicable, by selecting from the provided list.
5. If applicable, enter the primary isotopes and their activities for the individuals’ exposure in the designated fields.
6. In the same section, provide the names and email addresses of the department supervisor or manager overseeing the dosimetry series, as well as the dosimetry contact responsible for managing it.
7. Section 2 requires you to fill in billing and shipping information. Include the shipping address, billing contact, short code, department name, comments, phone number, fax number, and location details.
8. In Section 3, the designated supervisor or manager must authorize the request by printing their name, signing, and dating the authorization. Ensure this individual is the same as specified in Section 1.
9. Once all sections are completed, review the information for accuracy. Users can then save changes, download, print, or share the form as needed.

Start filling out the UMHHC - New Series Request Form online today.