ML031980424

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Revision 2 to EP-290005, Hospital Support Request Form
ML031980424
Person / Time
Site: Fermi DTE Energy icon.png
Issue date: 07/08/2003
From:
Detroit Edison
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML031980424 (2)


Text

DETROIT EDISON - FERMI 2 AUTOMATED RECORD MANAGEMENT DISTRIBUTION CONTROL LIST 07/08/03 To: 00935 US NRC PAGE 1 DOCUMENT CNTRL DESK WASHINGTON, DC 20555 Media: 8 1/2 X 11 Number Cnt Issue DTC Doc. Serial Number Page Rev Copies Lvi Date Sec Status TPEPT EP-290005 2 1 ST 07/08/03 AFC Please destroy or mark all revised, superseded, or cancelled documents as such. CONTROLLED stamps must be voided by lining through and initialing.

Detroit Edison EF2, C/O Info Mgmt 140 NOC, 6400 North Dixie Highway, Newport MI 48166. (734) 586-4338 OR (734) 586-4061 for questions or concerns.

Ref: cb3596

HOSPITAL SUPPORT REQUEST FORM NOTE: Mercy Memorial Hospital is the primary hospital. Use Oakwood Southshore Medical Center only if conditions prevent the use of Mercy Memorial Hospital.

Mercy Memorial Hospital: 734-242-6500 Oakwood Southshore Medical Center: 734-671-3883,734-671-3882, or 734-671-3881

1. This is:

Name:

Title Telephone Number calling from Fermi 2. There are injured personnel onsite and the ambulance service has been contacted to transport the victims to you.

2. Number of injured personnel:
3. Injuries to personnel:
4. Number of potentially contaminated personnel:
5. Number of personnel suffering from excessive radiation exposure:
6. If there are potentially contaminated personnel state the following:

"You are requested to implement your radiological emergency response plan."

7. Complete SAS notification.

DTC: TPEPT DSN: EP-290005 Rev. 2 PI/l FMle: 1703.10 Approved: 7-8-03 Issued: 7-8-03 File: 0926.09 IP: I