ML19037A088

Rmpp 3.2 Attachment 3.2-1 Radiological Incident Notification Form

ML19037A088
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: ML19037A067 ML19037A070 ML19037A072 ML19037A073 ML19037A075 ML19037A076 ML19037A077 ML19037A078 ML19037A079 ML19037A080 ML19037A081 ML19037A083 ML19037A084 ML19037A085 ML19037A087 ML19037A088 ML19037A089 ML19037A090 ML19037A091 ML19037A094 ML19039A362
References
Download: ML19037A088 (1)

Text

ATTACHMENT 3.2-1 TO RMPP 3.2, REVISION 0:

RADIOLOGICAL INCIDENT NOTIFICATION FORM Contact Information Name: __________________________________ Notification Date/Time: _____________ ____

Incident Reported By: On-site

Contact:

Name: Name:

Title/Organization: Title/Organization:

Phone Number: Phone Number:

Location of Incident (Include Directions):

Description of Incident:

Radiation Assessment:

1. Why do you believe radioactive material is involved?

2. Describe the radioactive material including packaging.

3. Did you observe any writing or inscriptions on the materials?

4. Are the shipping papers available?

5. Are there any indications of a possible spread of contamination based on meter readings, broken source housing, leaking packaging, etc.

6. Has the source or contaminated area been isolated or access to the area restricted?

7. What other agencies or personnel are involved?

Attachment 3.2-1 Revision 0