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{{#Wiki_filter:West Valley Site Management Program RECORD OF REVISION AND DISTRIBUTION TITLE: Personnel Decontamination Procedure for the Retained Premises RP-RPP008.00 Record of Revision: Description of Change(s)
{{#Wiki_filter:West Valley Site Management Program RECORD OF REVISION AND DISTRIBUTION TITLE: Personnel Decontamination Procedure for the Retained Premises                 RP-RPP008.00 Record of Revision:
Date Im (and pages affected)
Description of Change(s)                                                               Date     Im (and pages affected)                                                                   Issued RP-RPP008.00       Original issue                                                   04/19/2012 Record of Distribution:
Issued RP-RPP008.00 Original issue 04/19/2012 Record of Distribution:
Record of Distribution                                                                 Date (Distribution List)                                                                 Distributed RP-RPPO08.00       WVSMP Plans and Procedures Manuals                               04/19/2012 (AOC Office, SDA and Annex)
Record of Distribution (Distribution List)RP-RPPO08.00 WVSMP Plans and Procedures Manuals (AOC Office, SDA and Annex)Central Files (Original with green sheets)RP-RPPO08.00 Transmittal to Chad Glenn, NRC (under separate cover PJB/l2amdOl9.ejt)
Central Files (Original with green sheets)
Edward Traverso, RSO, RP-RSC, Controlled Binder 1 Tom Attridge, RP-RSC Controlled Binder 2 Paul Bembia, RP-RSC Controlled Binder 3 RP-RSC Controlled Binder 4 (never issued)Jean Williams, RP-RSC Controlled Binder 5 Duane Quayle, EnergySolutions, (Radiation and Safety Contractor Manager) RP-RSC Controlled Binder 6 Central Files 10512-12 -RP-RSC Controlled Binder 7 Elizabeth Lowes, RP-RSC Controlled Binder 8 Alita Dueringer, RP-RSC Controlled Binder 9 Date Distributed 04/19/2012 07/30/2012 FRM002.05 This page intentionally left blank.FRM002.05 West Valley Site Management Program Page 1 of 3 RETAINED PREMISES RADIATION PROTECTION PROCEDURES 04/19/2012
RP-RPPO08.00       Transmittal to Chad Glenn, NRC                                   07/30/2012 (under separate cover PJB/l2amdOl9.ejt)
Edward Traverso, RSO, RP-RSC, Controlled Binder 1 Tom Attridge, RP-RSC Controlled Binder 2 Paul Bembia, RP-RSC Controlled Binder 3 RP-RSC Controlled Binder 4 (never issued)
Jean Williams, RP-RSC Controlled Binder 5 Duane Quayle, EnergySolutions, (Radiation and Safety Contractor Manager) RP-RSC Controlled Binder 6 Central Files 10512 RP-RSC Controlled Binder 7 Elizabeth Lowes, RP-RSC Controlled Binder 8 Alita Dueringer, RP-RSC Controlled Binder 9 FRM002.05
 
This page intentionally left blank.
FRM002.05
 
West Valley Site Management Program                                                             Page 1 of 3 RETAINED PREMISES RADIATION PROTECTION PROCEDURES                                               04/19/2012


==SUBJECT:==
==SUBJECT:==
Personnel Decontamination Procedure for the Retained Premises RP-RPP008.00 1.0 PURPOSE This document establishes the West Valley Site Management Program's (WVSMP) requirements for documenting personnel contamination events and performing personnel decontamination following the discovery of radiological contamination of personnel and/or clothing on the Retained Premises of the Western New York Nuclear Service Center.2.0 GENERAL REQUIREMENTS NYSERDA will, on a task-specific basis, assess the potential for personnel contamination prior to performing work in any area where radioactive materials may be encountered in unknown concentrations.
Personnel Decontamination Procedure for the Retained Premises                     RP-RPP008.00 1.0     PURPOSE This document establishes the West Valley Site Management Program's (WVSMP) requirements for documenting personnel contamination events and performing personnel decontamination following the discovery of radiological contamination of personnel and/or clothing on the Retained Premises of the Western New York Nuclear Service Center.
Such assessments, with appropriate monitoring and decontamination requirements, will be documented in the radiation safety plan prepared for the work.When required by the task-specific radiation safety plan, personnel monitoring or frisking will be performed after the removal of protective clothing prior to decontamination.
2.0     GENERAL REQUIREMENTS NYSERDA will, on a task-specific basis, assess the potential for personnel contamination prior to performing work in any area where radioactive materials may be encountered in unknown concentrations.
Any personnel contamination event will be reported to the Radiation Safety Officer (RSO) immediately.
Such assessments, with appropriate monitoring and decontamination requirements, will be documented in the radiation safety plan prepared for the work.
Workers found with detectable radiological contamination on their skin and/or clothing will be promptly decontaminated.
When required by the task-specific radiation safety plan, personnel monitoring or frisking will be performed after the removal of protective clothing prior to decontamination. Any personnel contamination event will be reported to the Radiation Safety Officer (RSO) immediately. Workers found with detectable radiological contamination on their skin and/or clothing will be promptly decontaminated.
All sampling media (e.g., smears, nasal swabs, air samples, etc.) that are collected in response to a contamination event will be retained for possible dose evaluation until released by the RSO.The following precautions and limitations apply to all decontamination activities performed within the purview of the Retained Premises -Radiation Protection Program (RP-RPP): Lifesaving medical procedures shall always take precedence over the decontamination of personnel.
All sampling media (e.g., smears, nasal swabs, air samples, etc.) that are collected in response to a contamination event will be retained for possible dose evaluation until released by the RSO.
Decontamination of wounded or injured personnel shall only be performed by, or under the direction of, qualified medical personnel.
The following precautions and limitations apply to all decontamination activities performed within the purview of the Retained Premises - Radiation Protection Program (RP-RPP):
If a contaminated person is injured, the event will be treated as an emergency.
Lifesaving medical procedures shall always take precedence over the decontamination of personnel.
Contact the WVSMP Emergency Coordinator to initiate emergency response in accordance with ER100, Emergency Response Plan for the West Valley Site Management Program.Water used for the decontamination of personnel or personal articles shall be treated as contaminated (i.e., contained to prevent release to the environment and disposed of accordingly).
Decontamination of wounded or injured personnel shall only be performed by, or under the direction of, qualified medical personnel. If a contaminated person is injured, the event will be treated as an emergency. Contact the WVSMP Emergency Coordinator to initiate emergency response in accordance with ER100, Emergency Response Plan for the West Valley Site Management Program.
At the direction and/or discretion of the NYSERDA RSO or Radiation Safety Committee (RSC), tritium smears may be used to measure tritium contamination after personnel perform tasks that could potentially involve tritium contamination.
Water used for the decontamination of personnel or personal articles shall be treated as contaminated (i.e., contained to prevent release to the environment and disposed of accordingly).
Decontamination should take place upwind and'upslope from the scene of the contamination event to minimize further contamination resulting from any runoff created by decontamination activities.
At the direction and/or discretion of the NYSERDA RSO or Radiation Safety Committee (RSC),
Any runoff created by decontamination should be contained.
tritium smears may be used to measure tritium contamination after personnel perform tasks that could potentially involve tritium contamination.
RP-RPP008.00 Page 2 of 3 3.0 DECONTAMINATION PROCEDURES AND GUILDELINES Radiation safety personnel will conduct full body radiological surveys to monitor for radioactive material contamination using appropriate contamination detection equipment.
Decontamination should take place upwind and'upslope from the scene of the contamination event to minimize further contamination resulting from any runoff created by decontamination activities. Any runoff created by decontamination should be contained.
Personnel with detectable contamination (other than natural background contamination) on their skin or clothing should be promptly decontaminated.
 
Upon discovery of personnel contamination, radiation support personnel will have the individual minimize their movement to prevent the spread of contamination.
RP-RPP008.00                                                                                     Page 2 of 3 3.0     DECONTAMINATION PROCEDURES AND GUILDELINES Radiation safety personnel will conduct full body radiological surveys to monitor for radioactive material contamination using appropriate contamination detection equipment. Personnel with detectable contamination (other than natural background contamination) on their skin or clothing should be promptly decontaminated.
The NYSERDA RSO will be contacted immediately.
Upon discovery of personnel contamination, radiation support personnel will have the individual minimize their movement to prevent the spread of contamination. The NYSERDA RSO will be contacted immediately. Radiation support personnel will conduct additional monitoring to determine the extent of skin contamination prior to decontamination, and complete the WVSMP Retained Premises Personnel Contamination Report Form (Attachment A), describing the event in detail.
Radiation support personnel will conduct additional monitoring to determine the extent of skin contamination prior to decontamination, and complete the WVSMP Retained Premises Personnel Contamination Report Form (Attachment A), describing the event in detail.If contamination is discovered on the face, the radiation safety personnel will collect nasal swabs to determine if the contamination has been potentially inhaled. In addition, if nasal swabs indicate potential inhalation of contamination, or if contamination is discovered around the mouth or lips, a bioassay of the individual is required to determine the extent (if any) of internal contamination.
If contamination is discovered on the face, the radiation safety personnel will collect nasal swabs to determine if the contamination has been potentially inhaled. In addition, if nasal swabs indicate potential inhalation of contamination, or if contamination is discovered around the mouth or lips, a bioassay of the individual is required to determine the extent (if any) of internal contamination.
Because there is no ready source of potable water available on the Retained Premises, personnel decontamination will be usually be accomplished by using dry decontamination techniques (e.g., towel wipes and/or masking tape); however, any method included in the table below may be used. When required by the task-specific radiation safety plan, specific decontamination methods will be selected based on the contaminants likely to be encountered.
Because there is no ready source of potable water available on the Retained Premises, personnel decontamination will be usually be accomplished by using dry decontamination techniques (e.g., towel wipes and/or masking tape); however, any method included in the table below may be used. When required by the task-specific radiation safety plan, specific decontamination methods will be selected based on the contaminants likely to be encountered.
Personnel Decontamination Methods Person Authorized Method to Effective for Technique Administer Towel Wipes Radiation Skin contamination Wipe gently with absorbent towel. Be safety careful not to abrade skin.personnel Masking Tape Radiation Particulates Apply tape to skin by lightly patting and safety removing carefully.
Personnel Decontamination Methods Person Authorized Method             to             Effective for               Technique Administer Towel Wipes       Radiation       Skin contamination         Wipe gently with absorbent towel. Be safety                                     careful not to abrade skin.
personnel Soap and Radiation All skin contamination Wash area with low alkaline, non-abrasive Tepid Water safety soap and tepid water. Repeat until desired personnel contamination level has *been reached. A soft surgical hand brush may be used with moderate pressure.Shampoo Radiation Hair contamination Wash hair and rinse, keeping the head tilted safety backward and the direct flow of water away personnel from the face. Repeat as needed.Nose Blowing Individual Nasal contamination Blow nose with soft tissue. Repeat until_ survey of tissue shows no contamination.
personnel Masking Tape       Radiation       Particulates               Apply tape to skin by lightly patting and safety                                     removing carefully.
RP-RPP008.00 Page 3 of 3 Specific tools and equipment required by the task-specific radiation safety plan will be provided as part of the work planning process. Such equipment may include, but is not limited to, the following depending on the type and method of decontamination required: 0 Banner tape to indicate incident boundary and control zones* Mops and brushes* Large trash cans 0 Water supply 0 Different sizes of plastic bags 0 Plastic sheeting* Masking tape 0 Towel Wipes* " Shampoo* Detergent soap (mild soap for personnel)
personnel Soap and           Radiation       All skin contamination     Wash area with low alkaline, non-abrasive Tepid Water       safety                                     soap and tepid water. Repeat until desired personnel                                   contamination level has *been reached. A soft surgical hand brush may be used with moderate pressure.
* Safety cones* Buckets* Containment system, including secondary containment, for decontamination water runoff The individual will be surveyed following each successive round of decontamination.
Shampoo           Radiation       Hair contamination         Wash hair and rinse, keeping the head tilted safety                                     backward and the direct flow of water away personnel                                   from the face. Repeat as needed.
Decontamination will continue until successive rounds result in no change in contamination.
Nose Blowing     Individual       Nasal contamination         Blow nose with soft tissue. Repeat until
If decontamination cannot be achieved by the methods described above, the event will be treated as an emergency, and the NYSERDA Project Manager will contact the WVSMP Emergency Coordinator to initiate emergency response in accordance with ER100.4.0 RECORDKEEPING Contaminated areas of the skin will be measured and reported in square inches (or centimeters) with the activity recorded in net counts per minute (cpm) and net disintegrations per minute (dpm). Measurements will be documented on the WVSMP Retained Premises Personnel Contamination Report Form (Attachment A) and kept in the confidential WVSMP personnel files maintained by the WVSMP Office Manager.5.0 ATTACHMENTS Attachment A: WVMSP Retained Premises Personnel Contamination Report Form (one page).
_            survey of tissue shows no contamination.
This page intentionally left blank ATTACHMENT A WVSMP Retained Premises Personnel Contamination Report This page intentionally le/it blank.
 
Attachment A WVSMP Retained Premises Personnel Contamination Report Form Date/Time:
RP-RPP008.00                                                                                   Page 3 of 3 Specific tools and equipment required by the task-specific radiation safety plan will be provided as part of the work planning process. Such equipment may include, but is not limited to, the following depending on the type and method of decontamination required:
Name: Job Title: RWP #: Survey taken on El Skin E] Protective Clothing El Personnel Clothing Nasal Swabs taken? El No El Yes Bioassay Required?
0       Banner tape to indicate incident boundary and control zones
El No El Yes: Collection Date: Time: Mark location of contaminated areas on the charts below.FRONT Area Alpha Beta BACK Area Alpha Beta (cm 2) cpm/dpm cpm/dpm (cm 2) cpm/dpm cpm/dpm Q_ 2. / / 12. / /3. / / 13. /4. / 14. /5. 15. /6. 16.7. 17./8. /18./9. / / 19. / /10. / / 20. /T r Levels Following Decontamination (dpm)Location # 1st 2nd 3rd Decontamination Method (from above) Attempt Attempt Attempt Monitored by: Name/Organization Instrument Type: Instrument S/N RP-RPPOO8.00 Instrument efficiency:
* Mops and brushes
__robe used: Calibration Date: A-1 This page intentionally left blank.}}
* Large trash cans 0       Water supply 0       Different sizes of plastic bags 0       Plastic sheeting
* Masking tape 0       Towel Wipes
*"       Shampoo
* Detergent soap (mild soap for personnel)
* Safety cones
* Buckets
* Containment system, including secondary containment, for decontamination water runoff The individual will be surveyed following each successive round of decontamination. Decontamination will continue until successive rounds result in no change in contamination. If decontamination cannot be achieved by the methods described above, the event will be treated as an emergency, and the NYSERDA Project Manager will contact the WVSMP Emergency Coordinator to initiate emergency response in accordance with ER100.
4.0     RECORDKEEPING Contaminated areas of the skin will be measured and reported in square inches (or centimeters) with the activity recorded in net counts per minute (cpm) and net disintegrations per minute (dpm). Measurements will be documented on the WVSMP Retained Premises Personnel Contamination Report Form (Attachment A) and kept in the confidential WVSMP personnel files maintained by the WVSMP Office Manager.
5.0     ATTACHMENTS Attachment A: WVMSP Retained Premises Personnel Contamination Report Form (one page).
 
This page intentionally left blank ATTACHMENT A WVSMP Retained Premises Personnel Contamination Report
 
This page intentionally le/it blank.
Attachment A WVSMP Retained Premises Personnel Contamination Report Form Name:                                                                      Date/Time:
Job
 
==Title:==
RWP #:
Survey taken on     El Skin         E] Protective Clothing         El Personnel Clothing Nasal Swabs taken? El No     El Yes Bioassay Required?   El No   El Yes:     Collection Date:                         Time:
Mark location of contaminated areas on the charts below.
FRONT             Area       Alpha       Beta       BACK               Area       Alpha       Beta (cm 2)     cpm/dpm     cpm/dpm                       (cm 2)     cpm/dpm     cpm/dpm Q_       2.             /           /                         12.             /           /
: 3.             /           /                         13.             /
: 4.             /                                       14.                         /
: 5.                                                     15.             /
: 6.                                                     16.
: 7.                                                     17./
: 8.             /18./
: 9.             /           /                         19.             /           /
: 10.           /           /                         20.                         /
T                                                     r Levels Following Decontamination (dpm)
Location #       Decontamination Method                                  1st         2nd       3rd (from above)                                                               Attempt     Attempt   Attempt Monitored by:
Name/Organization Instrument Type:                                                       robe used:
Instrument S/N                           Instrument efficiency: __      Calibration Date:
RP-RPPOO8.00                                      A-1
 
This page intentionally left blank.}}

Latest revision as of 18:18, 5 December 2019

RP-RPP008.00, Personnel Decontamination Procedure for the Retained Premises.
ML12261A259
Person / Time
Site: West Valley Demonstration Project, P00M-032
Issue date: 04/19/2012
From:
State of NY, Energy Research & Development Authority
To:
NRC/FSME/DWMEP/DURLD
References
RP-RPP008.00
Download: ML12261A259 (10)


Text

West Valley Site Management Program RECORD OF REVISION AND DISTRIBUTION TITLE: Personnel Decontamination Procedure for the Retained Premises RP-RPP008.00 Record of Revision:

Description of Change(s) Date Im (and pages affected) Issued RP-RPP008.00 Original issue 04/19/2012 Record of Distribution:

Record of Distribution Date (Distribution List) Distributed RP-RPPO08.00 WVSMP Plans and Procedures Manuals 04/19/2012 (AOC Office, SDA and Annex)

Central Files (Original with green sheets)

RP-RPPO08.00 Transmittal to Chad Glenn, NRC 07/30/2012 (under separate cover PJB/l2amdOl9.ejt)

Edward Traverso, RSO, RP-RSC, Controlled Binder 1 Tom Attridge, RP-RSC Controlled Binder 2 Paul Bembia, RP-RSC Controlled Binder 3 RP-RSC Controlled Binder 4 (never issued)

Jean Williams, RP-RSC Controlled Binder 5 Duane Quayle, EnergySolutions, (Radiation and Safety Contractor Manager) RP-RSC Controlled Binder 6 Central Files 10512 RP-RSC Controlled Binder 7 Elizabeth Lowes, RP-RSC Controlled Binder 8 Alita Dueringer, RP-RSC Controlled Binder 9 FRM002.05

This page intentionally left blank.

FRM002.05

West Valley Site Management Program Page 1 of 3 RETAINED PREMISES RADIATION PROTECTION PROCEDURES 04/19/2012

SUBJECT:

Personnel Decontamination Procedure for the Retained Premises RP-RPP008.00 1.0 PURPOSE This document establishes the West Valley Site Management Program's (WVSMP) requirements for documenting personnel contamination events and performing personnel decontamination following the discovery of radiological contamination of personnel and/or clothing on the Retained Premises of the Western New York Nuclear Service Center.

2.0 GENERAL REQUIREMENTS NYSERDA will, on a task-specific basis, assess the potential for personnel contamination prior to performing work in any area where radioactive materials may be encountered in unknown concentrations.

Such assessments, with appropriate monitoring and decontamination requirements, will be documented in the radiation safety plan prepared for the work.

When required by the task-specific radiation safety plan, personnel monitoring or frisking will be performed after the removal of protective clothing prior to decontamination. Any personnel contamination event will be reported to the Radiation Safety Officer (RSO) immediately. Workers found with detectable radiological contamination on their skin and/or clothing will be promptly decontaminated.

All sampling media (e.g., smears, nasal swabs, air samples, etc.) that are collected in response to a contamination event will be retained for possible dose evaluation until released by the RSO.

The following precautions and limitations apply to all decontamination activities performed within the purview of the Retained Premises - Radiation Protection Program (RP-RPP):

Lifesaving medical procedures shall always take precedence over the decontamination of personnel.

Decontamination of wounded or injured personnel shall only be performed by, or under the direction of, qualified medical personnel. If a contaminated person is injured, the event will be treated as an emergency. Contact the WVSMP Emergency Coordinator to initiate emergency response in accordance with ER100, Emergency Response Plan for the West Valley Site Management Program.

Water used for the decontamination of personnel or personal articles shall be treated as contaminated (i.e., contained to prevent release to the environment and disposed of accordingly).

At the direction and/or discretion of the NYSERDA RSO or Radiation Safety Committee (RSC),

tritium smears may be used to measure tritium contamination after personnel perform tasks that could potentially involve tritium contamination.

Decontamination should take place upwind and'upslope from the scene of the contamination event to minimize further contamination resulting from any runoff created by decontamination activities. Any runoff created by decontamination should be contained.

RP-RPP008.00 Page 2 of 3 3.0 DECONTAMINATION PROCEDURES AND GUILDELINES Radiation safety personnel will conduct full body radiological surveys to monitor for radioactive material contamination using appropriate contamination detection equipment. Personnel with detectable contamination (other than natural background contamination) on their skin or clothing should be promptly decontaminated.

Upon discovery of personnel contamination, radiation support personnel will have the individual minimize their movement to prevent the spread of contamination. The NYSERDA RSO will be contacted immediately. Radiation support personnel will conduct additional monitoring to determine the extent of skin contamination prior to decontamination, and complete the WVSMP Retained Premises Personnel Contamination Report Form (Attachment A), describing the event in detail.

If contamination is discovered on the face, the radiation safety personnel will collect nasal swabs to determine if the contamination has been potentially inhaled. In addition, if nasal swabs indicate potential inhalation of contamination, or if contamination is discovered around the mouth or lips, a bioassay of the individual is required to determine the extent (if any) of internal contamination.

Because there is no ready source of potable water available on the Retained Premises, personnel decontamination will be usually be accomplished by using dry decontamination techniques (e.g., towel wipes and/or masking tape); however, any method included in the table below may be used. When required by the task-specific radiation safety plan, specific decontamination methods will be selected based on the contaminants likely to be encountered.

Personnel Decontamination Methods Person Authorized Method to Effective for Technique Administer Towel Wipes Radiation Skin contamination Wipe gently with absorbent towel. Be safety careful not to abrade skin.

personnel Masking Tape Radiation Particulates Apply tape to skin by lightly patting and safety removing carefully.

personnel Soap and Radiation All skin contamination Wash area with low alkaline, non-abrasive Tepid Water safety soap and tepid water. Repeat until desired personnel contamination level has *been reached. A soft surgical hand brush may be used with moderate pressure.

Shampoo Radiation Hair contamination Wash hair and rinse, keeping the head tilted safety backward and the direct flow of water away personnel from the face. Repeat as needed.

Nose Blowing Individual Nasal contamination Blow nose with soft tissue. Repeat until

_ survey of tissue shows no contamination.

RP-RPP008.00 Page 3 of 3 Specific tools and equipment required by the task-specific radiation safety plan will be provided as part of the work planning process. Such equipment may include, but is not limited to, the following depending on the type and method of decontamination required:

0 Banner tape to indicate incident boundary and control zones

  • Mops and brushes
  • Large trash cans 0 Water supply 0 Different sizes of plastic bags 0 Plastic sheeting
  • Masking tape 0 Towel Wipes
  • " Shampoo
  • Detergent soap (mild soap for personnel)
  • Safety cones
  • Buckets
  • Containment system, including secondary containment, for decontamination water runoff The individual will be surveyed following each successive round of decontamination. Decontamination will continue until successive rounds result in no change in contamination. If decontamination cannot be achieved by the methods described above, the event will be treated as an emergency, and the NYSERDA Project Manager will contact the WVSMP Emergency Coordinator to initiate emergency response in accordance with ER100.

4.0 RECORDKEEPING Contaminated areas of the skin will be measured and reported in square inches (or centimeters) with the activity recorded in net counts per minute (cpm) and net disintegrations per minute (dpm). Measurements will be documented on the WVSMP Retained Premises Personnel Contamination Report Form (Attachment A) and kept in the confidential WVSMP personnel files maintained by the WVSMP Office Manager.

5.0 ATTACHMENTS Attachment A: WVMSP Retained Premises Personnel Contamination Report Form (one page).

This page intentionally left blank ATTACHMENT A WVSMP Retained Premises Personnel Contamination Report

This page intentionally le/it blank.

Attachment A WVSMP Retained Premises Personnel Contamination Report Form Name: Date/Time:

Job

Title:

RWP #:

Survey taken on El Skin E] Protective Clothing El Personnel Clothing Nasal Swabs taken? El No El Yes Bioassay Required? El No El Yes: Collection Date: Time:

Mark location of contaminated areas on the charts below.

FRONT Area Alpha Beta BACK Area Alpha Beta (cm 2) cpm/dpm cpm/dpm (cm 2) cpm/dpm cpm/dpm Q_ 2. / / 12. / /

3. / / 13. /
4. / 14. /
5. 15. /
6. 16.
7. 17./
8. /18./
9. / / 19. / /
10. / / 20. /

T r Levels Following Decontamination (dpm)

Location # Decontamination Method 1st 2nd 3rd (from above) Attempt Attempt Attempt Monitored by:

Name/Organization Instrument Type: robe used:

Instrument S/N Instrument efficiency: __ Calibration Date:

RP-RPPOO8.00 A-1

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