ML19037A076
| ML19037A076 | |
| Person / Time | |
|---|---|
| Issue date: | 02/08/2019 |
| From: | White A Office of Nuclear Material Safety and Safeguards |
| To: | state of VT |
| Shared Package | |
| ML19037A060 | List: |
| References | |
| Download: ML19037A076 (3) | |
Text
Attachment 3.1-1 Revision 0 ATTACHMENT 3.1-1 to RMPP 3.1, Revision 0:
Initial Contact Log VERMONT DEPARTMENT OF HEALTH Radioactive Materials Program INITIAL ALLEGATION CONTACT PHONE LOG INSTRUCTIONS:
This log is to be used to record the information gathered in an allegation against a licensee or registered user.
Inform the individual of the conditions regarding confidentiality.
YES - the individual was notified, and all information deemed sensitive is indicated on the below report.
Individual has requested confidentiality.
Individual has declined confidentiality.
ALLEGER INFORMATION:
Individuals full name:
Telephone number:
Position or relationship to the facility or activity involved:
Allegers employer:
Home mailing address:
Facility / location:
What sort of activities or practices did this involve? What have they observed? Use back for additional information.
NATURE AND DETAILS OF THE ALLEGATION:
How long has this activity been occurring?
Why do they believe this to be a safety concernDescription of the Concern?
Is this a current or past unsafe practice?
How did the individual find out about the concern?
Date(s) and times of occurrence:
Are there other individuals who should be contacted for additional information?
(list names, addresses, phone number if available)
What records does the individual think should be reviewed?
Has the individual raised the concerns with his/her management?
Yes What action has been taken?
No Why not?
Commented [SJ1]: Not all allegations come from phone calls Commented [SJ2]: As noted in the procedures, not all allegations involve safety concerns. See suggested revisions to broaden intake of concern.
.1-1 Revision 0 If the allegation involves discrimination because of age, sex, race, etc., inform the alleger that they should contact the State of Vermont Human Rights Commission at (802) 828-1625.
- If this allegation was forwarded from another agency, indicate who the contact was that provided the notification:
Agency:
Region/Office:
Name:
Telephone:
ACTIONS TO BE TAKEN:
Refer this to the Radiation Control Program Director If this issue was referred to another agency, please list the name of agency:
ADDITIONAL COMMENTS OR INFORMATION:
.1-1 Revision 0