Report Lost Dosimeter

If a lost dosimeter is found, please return to EHS immediately with a note explaining this is a lost badge, and the approximate date it was misplaced. EHS is charged for each unreturned dosimeter by the vendor.

Personal Information

Name (last, first, middle):

ID Number:

ID Type:

Sex:

Date of Birth:

Principal Investigator:

Department:

Building Name:

Room Number:

Phone Number:

Email Address:

Replacement Information

Type of Badge Needing Replacement:

Number of Finger Badges:

Dosimeter Ring Size:

Date Last Used:

Comments:

Username

EHS Home Page

Environmental Health & Safety Info Portal

Report Lost Dosimeter

Personal Information

Replacement Information

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