Last Revised: July 08, 2021

A red asterisk indicates a required field.  To learn more about radiation dosimeters, visit our Personnel Monitoring page.  

Employees who have been issued dosimeters may contact EHRS (215-898-7187) to review their individual record of doses received.

Applicant Information

Name
Title

Current or Prior Radiation Work & Exposure History

Are you currently or have you been previously monitored for your work with radioactive materials and/or radiation producing equipment? This includes as an employee or student.

 

If yes, please list your current and previous radiation work history below. Please include requested information for each location of prior radiation work.

 

Prior Radiation Work Location 1
Contact Name
Title
Contact Name
Title
Contact Name
Title
Contact Name
Title
Please choose one of the following three options:

Dosimeter Request Details

In addition to a full body monitoring dosimeter, are you requesting a ring dosimeter?
If yes, what size ring dosimeter?
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