Change Dosimeter Information

If you have questions or are unable to complete this form, please contact EHS at 517-355-0153.

Personal Information

APID ZPID Passport
APID ZPID Passport
Male Female
Male Female

 

Usage Information

Small Medium/Large Extra Large

 

Radioactive Materials Exposure

Yes No

 

Radiation-Producing Machine Exposure

Yes No
Analytic
Radiographic X-Ray
Fluoroscopy X-Ray
X-Ray Diffraction
PET / CT
PET Cyclotron
SPECT

 

Pregnancy

Contact the Radiation Safety Officer for information for pregnant workers at 355-0153 or ehs@msu.edu.

 

 

Comments

 

 

Confirmation

I certify that the information submitted in this request is true and correct to the best of my knowledge.

I further understand that any intentionally false information may result in sanctions from the Radiation Safety Committee.

Agree

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