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Detroit Edison Tpept EP-29005, Rev 3, Hospital Support Request Form
2022-03-02
[Table view] |
Text
DETROIT EDISON - FERMI 2 AUTOMATED RECORD MANAGEMENT DISTRIBUTION CONTROL LIST 10/24/03 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Number Page Rev Copies Lvi Date Sec Status TPEPT EP-290005 3 1 ST 10/24/03 AFC Please destroy or mark all revised, superseded, or cancelled documents as such.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 4N0YS
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: 734-240-8404 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:
Kj
- 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 Rv. 3 Pl/l File: 1703.10 Approved: /d -a 5 -o3 Issued: Z-a.*..3 File: 0926.09 IP: I
