ML003739482

Rev 1(Draft Was Issued as DG-8007)Instructions for Recording and Reporting Occupational Radiation Exposure Data

ML003739482
Person / Time
Issue date:	06/30/1992
From:	Office of Nuclear Regulatory Research
To:
References
-RFPFR, DG-8007 RG-8.007, Rev 1
Download: ML003739482 (16)

Text

U.S. NUCLEAR REGULATORY COMMISSION REGULATORY Revision 1 June 1992 GUIDE OFFICE OF NUCLEAR REGULATORY RESEARCH REGULATORY GUIDE 8.7 (Draft was issued as DG-8007)

INSTRUCTIONS FOR RECORDING AND REPORTING OCCUPATIONAL RADIATION EXPOSURE DATA A. INTRODUCTION Section 20.1502 of 10 CFR Part 20, "Standards for Protection Against Radiation," requires licensees to provide radiation monitoring for all occupationally exposed individuals who might receive a dose in ex-cess of 10 percent of the limits in 10 CFR 20.1201, 20.1207, or 20.1208. In 10 CFR 20.2106, licensees are required to maintain records of the radiation ex-posures of all individuals for whom personnel moni-toring is required (pursuant to 10 CFR 20.1502). Ac-cording to 10 CFR 20.2104, the dose in the current monitoring year must be determined for all persons who must be monitored, and this information must be recorded on NRC Form 4 or equivalent. In addition, 10 CFR 20.2104 requires that, prior to allowing an individual to participate in a planned special expo-sure, records of all prior exposures must be acquired.

Records of prior dose must be maintained on NRC Form 4 or its equivalent. Further, 10 CFR 20.2206 requires certain licensees to submit an annual report to NRC of the results of individual monitoring.

This guide describes an acceptable program for the preparation, retention, and reporting of records of occupational radiation exposures. It includes cop-ies of NRC Forms 4 and 5 and detailed instructions on completing them.

Any information collection activities mentioned in this, regulatory guide are contained as requirements in 10 CFR Part 20, which provides the regulatory ba-sis for this guide. The information collection require-ments in 10 CFR Part 20 have been cleared under OMB Clearance No. 3150-0014. The existing re-quirements for NRC Forms 4 and 5 were approved by the Office of Management under approval numbers 3150-0005 and 3150-0006.' The amended informa-tion collection requirements reflected in this guide and contained on the revised NRC Forms 4 and 5 will not become effective until after they are approved by the Office of Management and Budget. Notice of OMB approval will be published in the Federal Regis-ter.

B. DISCUSSION This guide is structured to reflect the process a licensee would go through in deciding whether or not monitoring for occupational exposure to radiation is required under the revised 10 CFR Part 20. The guide describes acceptable methods for determination of prior exposures, records of monitoring provided, and reporting that are needed to comply with 10 CFR Part 20. NRC Forms 4 and 5 are provided. A format for electronically reporting exposure data to NRC is provided in Appendix A.

In order to avoid confusion with the acronym for effective dose equivalent (EDE), the abbreviation LDE is used to represent the eye (lens) dose equiva-lent, as defined in 10 CFR Part 20. The term total organ dose equivalent (TODE) has been added, and it means the sum of the deep dose equivalent and the USNRC REGULATORY GUIDES Regulatory Guides are issued to describe and make available to the pub-lic methods acceptable to the NRC staff of implementing specific parts of the Commission's regulations, to delineate techniques used by the staff in evaluating specific problems or postulated accidents, or to pro-vide guidance to applicants. Regulatory Guides are not substitutes for regulations, and compliance with them Is not required. Methods and solutions different from those set out In the guides will be acceptable If they provide a basis for the findings requisite to the issuance or continu-ance of a permit or license by the Commission.

This guide was issued after consideration of comments received from the public. Comments and suggestions for improvements In these guides are encouraged at all times, and guides will be revised, as ap-propriate, to accommodate comments and to reflect new information or experience.

Written comments may be submitted to the Regulatory Publications Branch, DFIPS, ARM, U.S. Nuclear Regulatory Commission, Washing-ton, DC 20555.

The guides are issued in the following ten broad divisions:

1. Power Reactors

2. Research and Test Reactors

3. Fuels and Materials Facilities

4. Environmental and Siting

5. Materials and Plant Protection

6. Products

7. Transportation

8. Occupational Health

9. Antitrust and Financial Review

10. General Copies of issued guides may be purchased from the Government Printing Office at the current GPO price. Information on current GPO prices may be obtained by contacting the Superintendent of Documents, U.S.

Government Printing Office, Post Office Box 37082, Washington, DC 20013-7082, telephone (202)275-2060 or (202)275-2171.

Issued guides may also be purchased from the National Technical Infor-mation Service on a standing order basis. Details on this service may be obtained by writing NTIS, 5285 Port Royal Road, Springfield, VA 22161.

committed dose equivalent to the organ receiving the highest dose as described in 10 CFR 20.2106(a)(6).

C. REGULATORY POSITION

1.

DETERMINATION OF MONITORING REQUIREMENTS According to 10 CFR 20.1502, if an adult is likely to receive in 1 year a dose greater than 10 per-cent of any applicable limit, monitoring is required.

The licensee should perform an evaluation of the dose the individual is likely to receive prior to allow-ing the individual to receive the dose. This evaluation need not be made for every individual; evaluations can be made for employees with similar job functions or work areas. Further guidance on evaluating the need to provide monitoring is provided in Regulatory Guide 8.34, "Monitoring Criteria and Methods To Calculate Occupational Doses."

1.1 If Monitoring Is Not Required If this prospective evaluation shows that the indi-vidual is not likely to exceed 10 percent of any appli-cable limit, there are no recordkeeping or reporting requirements in regard to the individual's exposure.

For individuals who received exposure at other facili-ties in the current year, the previous dose need not be considered in this prospective evaluation. Only dose that could be received at the facility performing the evaluation need be considered when determining the need for monitoring and, therefore, the record-keeping and reporting requirements. If it is deter-mined that monitoring is not required and a subse-quent evaluation shows that the 10 percent threshold has or will be exceeded, the dose received when monitoring was not provided should be estimated, re-corded, and reported. These estimates can be based on any combination of work location radiation moni-toring or survey results, monitoring results of individu-als in similar work situations, or other estimates to produce a "best estimate" of the actual dose re-ceived.

If monitoring is not required to demonstrate com-pliance with all limits but is required relative to one or more specific limits, the licensee should enter "NR" in the blocks on NRC Forms 4 and 5 to indicate the areas for which monitoring was not required (e.g., ex-tremity or skin doses). Where monitoring was pro-vided but not measurable, the licensee should enter "ND" for "Not Detectable."

1.2 If Monitoring Is Required If the prospective evaluation shows that the indi-vidual is likely to exceed 10 percent of an applicable limit, monitoring is required (10 CFR 20.1502). Re-cording and reporting of the results of monitoring per-formed, regardless of the actual dose received, is re-quired by 10 CFR 20.2106(a) and 20.2206(b) re-spectively.

1.3 Documentation of Prior Exposures For those individuals for whom monitoring is re-quired, determination of current year exposure at other facilities is required by 10 CFR 20.2104. To document the determination of current year expo-sure, the individual to be monitored must provide an NRC Form 4 signed by the individual or a written statement that includes the names of all facilities that provided monitoring for occupational exposure to ra-diation during the current year and an estimate of the dose received. Although not required by the regula-tions, it is considered good health physics practice to verify the information provided by the individual.

Verification may be documented with:

An NRC Form 5 for each listed monitoring pe-riod, or Electronic, telephone, or facsimile transfer of dose data provided by licensees listed on the written statement, or An NRC Form 4 countersigned by a licensee or current employer.

In addition, 10 CFR 20.2104(a) (2) requires that licensees attempt to obtain the records of lifetime cu-mulative occupational radiation dose. To demonstrate compliance with this requirement, the individual to be monitored may provide a written estimate of the cu-mulative lifetime dose or an up-to-date NRC Form 4 signed by the individual. This information need not be verified so long as the individual does not partici-pate in a planned special exposure.

NRC Forms 4 and 5 and termination letters or reports, which report the results of monitoring prior to implementation of the revised 10 CFR Part 20, may be used without recalculating dose according to the requirements of the revised 10 CFR Part 20. For the purpose of assessing prior dose, whole body dose in rem as reported on the old (1981 or earlier) NRC Forms 4 and 5 can be considered equivalent to total effective dose equivalent (TEDE).

1.4 Records of Prior Exposure for Persons Participating in Planned Special Exposures If there are any periods of exposure during.the life of the monitored individual that have not been determined and documented, participation in a planned special exposure is not permitted. Accept-able documentation of prior exposure is similar to that required for documenting current-year exposure.

Alternatively, the licensee may request in writing that a report of the monitored individual's exposure his-tory be provided by the NRC. To request an exposure history, the licensee may send a request signed by the monitored individual to:

REIRS Project Manager Office of Nuclear Regulatory Research U. S. Nuclear Regulatory Commission Washington, DC 20555 The request should contain the social security number (or other unique identifying number) of the 8.7-2

monitored individual authorizing release of the information and the name and address of the person or licensee to whom the report should be sent. The REIRS database contains only reports submitted by the seven classes of licensees required by 10 CFR Part 20 to report occupational exposures. Any missing monitoring periods should be obtained directly from licensees.

1.5 Individuals with No Social Security Number Doses to individuals who do not have a social se-curity number, such as citizens of foreign countries, should be reported using another unique identi-fication number. It is important to record the type of identification used in the data block labeled "ID type" that follows the "Identification Number" data block on NRC Form 4 and 5. The appropriate code listed below should be inserted in the blank labeled ID Type.

ID TYPE CODE U. S. Social Security Number SSN Passport Number PPN Canadian Social Insurance Number CSI Work Permit Number WPN INDEX Identification Number IND Other OTH The use of licensee-generated identification num-bers should be avoided whenever possible.

2.

RECORDS OF MONITORING RESULTS FOR INDIVIDUALS FOR WHOM MONITORING IS REQUIRED The preparation of NRC Form 5 with the infor-mation clearly and legibly shown, or the collection of all the information requested by NRC Form 5 using paper or electronic media (see Appendix A), is re-quired by 10 CFR 20.2106. Such a record must be maintained for each individual for whom personnel monitoring, is required by 10 CFR 20.1502. In addi-tion, certain classes of licensees report the results of this monitoring to NRC pursuant to 10 CFR 20.2206 either by submitting copies of NRC Form 5 or by transmitting the required information to NRC through electronic media. This report is filed annually. In-structions and additional information pertinent to each item are contained on Form 5.

2.1 Multiple Badges Further guidance on interpreting the results of multiple dosimetric devices placed at different loca-tions within a single dose category is provided in Regulatory Guide 8.34, "Monitoring Criteria and Methods To Calculate Occupational Doses."

2.2 Dose Calculations for CDE and TODE to the Maximally Exposed Organ Licensees are required by 10 CER 20.2106(a) (6) to record the total organ dose equivalent (TODE),

which is the sum of the deep dose equivalent (DDE) and the committed dose equivalent (CDE) to the or-gan receiving the highest dose. Organ doses need not be calculated if the committed effective dose equiva-lent (CEDE) does not exceed 1 rem and.there are no overexposures in any dose category within the moni-toring year, including doses previously reported by other licensees. In this case, the licensee may record "NC" for "Not Calculated" in items 16 and 18 on NRC Forms 4 and 5. If during the course of the year the dose to date for the year exceeds 1 rem CEDE or the individual receives an overexposure in another dose category, the CDE to the maximally exposed or-gan must be calculated, recorded, and reported.

When CDE and TODE to the maximally exposed or-gan must be calculated, the licensee should refer to Regulatory Guide 8.34, "Monitoring Criteria and Methods To Calculate Occupational Doses."

2.3 Dose to the Embryo/Fetus A declared pregnant worker is a worker who has voluntarily informed her employer in writing of her pregnancy and the estimated month and year of con-ception. The embryo/fetus' dose for the entire gesta-tion period must be recorded (10 CFR 20.2106(e)),

but need not be included on NRC Forms 4 and 5.

Multiple records are not required in the case of twins, triplets, etc. Any dose measured to demonstrate com-pliance with 10 CFR 20.1208 must be recorded.

Licensees should be sensitive to the issue of per-sonal privacy with regard to embryo/fetus dose. If re-quested by the monitored woman, a letter report may be provided to subsequent licensees to document prior embryo/fetus dose. Further guidance on assess-ing dose to the embryo/fetus is provided in Regulatory Guide 8.36, "Radiation Dose to the Embryo/Fetus."

2.4 Transmittal of Reports to the NRC Certain licensees are required by 10 CFR 20.2206(c) to submit reports of monitoring for the previous year to NRC on or before April 30. These reports should be sent to:

REIRS Project Manager Office of Nuclear Regulatory Research U.S. Nuclear Regulatory Commission Washington, DC 20555 According to 10 CFR 20.2206(b), "...The licen-see shall use Form NRC 5 or electronic media con-taining all the information required by Form NRC 5."

2.5 Electronic Reporting of Exposure Data Licensees are encouraged to record and report these data electronically. The format for reporting radiation exposure data in an electronic, machine-readable format is provided in Appendix A of this guide.

8.7-3

D. IMPLEMENTATION The purpose of this section is to provide informa-tion to applicants and licensees regarding the NRC staff's plan for using this regulatory guide.

Except in those cases in which an applicant pro-poses an acceptable alternative method for complying with specified portions of the Commission's regulations, the methods described in this guide will be used in the evaluation of applications for new licenses, license renewals, and license amendments and for evaluating compliance with 10 CFR 20.100 1-20.240 1.

8.7-4

PAGE OF lO U'

NRC FORM 4 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO. 31504005 (6 921 EXPIRES:

10 CFR PART 20 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTION REQUEST:

MINUTES.

FORWARD CUMULATIVE OCCUPATIONAL EXPOSURE HISTORY COMMENTS REGARDING BURDEN ESTIMATE TO THE INFORMATION AND RECORDS MANAGEMENT BRANCH IMNBE 7714),

U.S, NUCLEAR REGULATORY COMMISSION, WASHINGTON, DC 20555. AND TO THE PAPERWORK REDUCTION PROJECT 13150-00051.

OFFICE OF MANAGEMENT AND BUDGET. WASHINGTON, DC 20503.

1. NAME tLAST. FIRST, MIDDLE INITIALI

2. IDENTIFICATION NUMBER

3. ID TYPE MALE

5. DATE OF BIRTH

4. SEX FEMALE S. MONITORING PERIOD

7. LICENSEE NAME

8. LICENSE NUMBER

9.

RETOD

10.

ROUTINE ESTIMATE NO RECORD tSE

11. DDE

12. LDE

13. SDE, WS

14. SDE. ME 1b. CEDE

18. CDE

17. TEDE

18. TODE

6. MONITORING PERIOD -7.

LCENSEE NAME B. LICENSE NUMBER

9.

RECORD

10.

ROUTINE ESTIMATE NO RECORD PSE 11 DDE

12. LDE

13. SDE, Wl

14. SDE, ME

16. CEDE

17. TEDE

18. TODE

6. MONITORING PERIOD

7. LICENSEE NAME

8. LICENSE NUMBER

9.

RECORD

10.

ROUTINE ESTIMATE NO RECORD PSE IDDE 12.LOE 13.SDE,W T

14. SDEME 16.CEDE 10.CDE 17 TEDE IB. TODE

6. MONITORING PERIOD

7. LICENSEE NAME

8. LICENSE NUMBER

9.

RECORD

10.

ROUTINE ESTIMATE NO RECORD PSE

11. DDE

12. LDE

13. SDE, W8

14. SDE, ME

16. CEDE

17. TEDE

19. TODE

6. MONITORING PERIOD

7. LICENSEE NAME

8. LICENSE NUMBER

9.

RECORD

10.

ROUTINE ESTIMATE NO RECORD PSE

11. DOE

12. LDE

13. SDE. W8

14. SDE, ME

16. CEDE

16. C17.

TEDE

18. TODE S. MONITORING PERIOD

7. LICENSEE NAME U. LICENSE NUMBER B.

RECORD

10.

ROUTINE ESTIMATE NO RECORD PSE Il.DODE

12. LDE

13. SDE, WB

14. SDE, ME 1ISCEDE is. COE

7. TEDE 1iBTODE

19. SIGNATURE OF MONITORED INDIVIDUAL

20. DATE SIGNED

21. CERTIFYING ORGANIZATION

22. SIGNATURE OF DESIGNEE

23. DATE SIGNED FR 4

NRC FORM 4 IG-921

INSTRUCTIONS AND ADDITIONAL INFORMATION PERTINENT TO THE COMPLETION OF NRC FORM 4 (A# doses shotdd be stated in rams]

PRIVACY ACT STATEMENT 1

Type or print the full name of the monitored individual in the order of lost name linclude Jr.

Sr. 'III, etc.). first name, middle initial (if applicable).

2.

Enter the individual's identification number. Including punctuation. This number should be the 9-dIgIt social security number if at all possible. If the Individual has no social security number, enter the number from another official identification such es a passport or work permit.

3.

Enter the code for the type of Identification used as shown below:

exposures received during the monitoring period. If more then one PSE was received in a single year. the licensee should sum them and report the total of all PSEs.

tI.

12.

Enter the deep dose equivalent IDDE) to the whole body.

Enter the eye dose equivalent (LOEI recorded for the lens of the eye.

CODE SSN

-PPN CSI WPN IND oTH ID TYPE U.S. Social Security Number Passport Number Canadian Social Insurance Number Work Permit Number INDEX Identification Number Other

4.

Check the box that denotes the sex of the individual being monitored.

5.

Enter the date of birth of the Individual being monitored in the format MMWDD/YY.

6.

Enter the monitoring period for which this report is filed.

The format should be MM/DD/YY - MM/DD/YY.

7.

Enter the name of the licensee or facility not licensed by NRC that provided monitoring.

0.

Enter the NRC license number or numbers.

9.

Place an X in Record. Estimate, or No Record. Choose

'Record' if the dose data listed represent a final deternination of the dose received to the best of the licensee's knowledge.

Choose Estimate' only if the fisted dose data are preliminary and will be superseded by a final determination resulting in a subsequent report. An example of such an instance would be dose data based on sell-reading dosimeter results and the licenses intends to assign the record dose on the basis of TLD results that are not yet available.

10.

Place an "X in either Routine or PSE. Choose 'Routine' if the date represent the results of monitoring for routine exposures.

Choose PSE if the listed dose data represents the results of monitoring of planned special

13.

Enter the shallow dose equivalent recorded for the skin of the whole body ISDEWBI.

14.

Enter the shallow dose equivalent recorded for the skin of the extremity receiving the maximum dose ISDEMEI.

15.

Enter the committed effective dose equivalent ICEDEI.

16.

Enter the committed dose equivalent ICDEI recorded for the maximally exposed organ.

17.

Enter the total effective dose equivalent ITEDEI.

The TEDE l the sum of items 11 and 15.

18.

Enter the total organ dose equivalent ITODEI for the maximally exposed organ. The TODE is the sum of items 11 and 16.

19.

Signature of the monitored individual.

The signature of the monitored Individual on this form indicates that the Information contained on the form is complete and correct to the best of his or her knowledge.

20.

Enter the date this form was signed by the monitored Individual.

21.

IOPTIONALI Enter the name of the licensee or facility not licensed by NRC. providing monitoring for exposure to radiation (such as a DOE facilityl or the employer if the individual is not employed by the licensee and the employer chooses to maintain exposure records for its employees.

22.

IOPTIONALI Signature of the person designated to represent the licensee or employer entered in item 21.

The licensee or employer who chooses to countersign the form should have on file documentation of all the information on the NRC Form 4 being signed.

Pursuant TO 5 U.S.C. 552a~e1)31. enected into law by Section 3 of the Privacy Act of 1974 IPublic Law 93-5791. the following statement is fumished to individuals who supply information to the U.S. Nuclear Regulatory Commission on NRC Form 4. This information is maintained In a system of records designated as NRC-27 and described at 55 Federal Register 33984 lAugust 20, 19901. or the most recent Federal Register publication of the Nuclear Regulatory Commission's Republication of Systems ol Records Notices' that is available at the NRC Public Document Room, Gelman Building. Lower Level, 2120 L Street NW, Washington. D.C.

1.

AUTHORITY:

Sections 53. 63. 65. 81. 103. 104. 161 Ibl. and 1611nD of the Atomic Energy Act of 1954. as amended 142 U. S. C. 2073. 2093. 2095, 2111.

2133, 2134, 2201(b), and 22011o11.

The authority for soliciting the social security number is 10 CFR Part 20.

2.

PRINCIPAL PURPOSEISI:

The information is used by the NRC in its evaluation of the risk of radiation exposure associated with the licensed activity and in exercising its statutory responsibility to monitor and regulate the safety and health practices of its licensees. The data permits a meaningful comparison of both current and long-term exposure experience among types of licensees and among licensees within each type.

Data on your exposure to radiation ia available to you upon your request.

3.

ROUTINE USEISi:

The information may be used to provide data to other Federal and State agencles Involved in monitoring and/or evaluating radiation exposure received by Individuals employed as radiation workers on a permanent or temporary basis and exposure received by monitored visitors.The information may also be disclosed to an appropriate Federal, State, or local agency in the event the information indicates a violation or potential violation o law and in the course of an administrative or judicial proceeding.

4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION:

It is voluntary that you fumish the requested Information, including social security number; however.

the licensee must complete NRC Form 5 on each individual for whom personnel monitoring is required under 10 CFR 20.2106. Failure to do so may subject the licensee to entorcement action in accordance with 10 CFR 20 2401. The social security number is used to assure that NRC has an aeccurate identifier not subject to the coincidence of similar names or birthdates among the large number of persons on whom data is maintained.

5.

SYSTEM MANAGERISI AND ADDRESS:

REIRS Project Manager Office of Nuclear Regulatory Research U.S. Nuclear Regulatory Commission Washington, DC 20555

23.

IOPTIONALI Enter the date this form was signed by the designated representative.

PAGE OF NRC FORM 6 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO. 3150-0006 (6-92)

EXPIRES:

10 CFR PART 20 OCCUPATIONAL EXPOSURE RECORD ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS OCC PA IO ALEXP SU E

EC RDINFORMATION COLLECTION REQUEST:

MINUTES.

FOR A MONITORING PERIOD HFORWAR COMMENTS REGARDING BURDEN ESTIMATE TO THE INFORMATION AND RECORDS MANAGEMENT BRANCH (MNBB 7714), U.S. NUCLEAR REGULATORY COMMISSION.

WASHINGTON, DC

20555, AND TO THE PAPERWORK REDUCTION PROJECT (3150-0006\\,

OFFICE OF MANAGEMENT AND BUDGET, WASHINGTON, DC 20503-

1. NAME (LAST. FIRST. MIDDLE INITIAL) 2 IDENTIFICATION NUMBER

3. ID TYPE

4. SEX

6. DATE OF BIRTH

___J.MALE FEM ALEE

6. MONITORING PERIOD

7.

LICENSEE NAME NSE NUMBERSA 9A.

98.

_NE RECORD

_ROUTINE ESTIMATEPSE INTA.KES DOSES (in rem) 10A. RADIONUCLIDE 1OB. CLASS IOC. MODE 1OD. INTAKE INjuCI 11.

DEEP DOSE EQUIVALENT (DDE) 12 EYE DOSE EQUIVALENT TO THE LENS OF THE EYE ILDE) 12.

13.

SHALLOW DOSE EQUIVALENT, WHOLE BODY (SDE,WB) 14.

SHALLOW DOSE EQUIVALENT, MAX EXTREMITY (SDEME) 15.

COMMITTED EFFECTIVE DOSE EQUIVALENT (CEDE)

COMMITTED DOSE EQUIVALENT, 16.

MAXIMALLY EXPOSED ORGAN (CDE)

TOTAL EFFECTIVE DOSE EQUIVALENT 17.

(BLOCKS 11 + 151 (TEDE)

TOTAL ORGAN DOSE EQUIVALENT, 18.

MAX ORGAN (BLOCKS I1+ 16)

(TODE)

19. COMMENTS

20. SIGNATURE -- LICENSEE

21. DATE PREPARED NRC FORM 5 (6-92)

'F INSTRUCTIONS AND ADDITIONAL INFORMATION PERTINENT TO THE COMPLETION OF NRC FORM 5 (Al doses shoadd be stated in rems)

PRIVACY ACT STATEMENT 11 I

1 Type or print the full name of the monitored individual h the order of lest name (include 'Jr.'

'Sr,' 'l1.' etc.).

first name, middle initial (if applicable).

2.

Enter the individual's identification number, including punctuation. This number should be the 9-digit social security number if at all possible. If the individual has no social security number, snter the number from another official identification such a a passport or work permit.

3.

Enter the code for the typo of identification used as shown below:

CODE SSN PPN CSI WPN IND OTH iD TYPE U.S. Social Security Number Pasaport Number Canadian Social insurance Number Work Permit Number INDEX Identification Number Other period. If more than one PSE was received in a single year, the licensee should sum them and report the total of all PSEa.

0A. Enter the symbol for each radionuclide that resulted in an internal exposure recorded for the individual, using the format 'Xx- ##x,' for instsnce. Cs-137 or Tc-99m.

10B. Enter the lung clearance class as listed in Appendix B to 10 CFR Part 20.1001-2401 ID, W. Y. V, or 0 for other) for all intakes by inhalation.

IOC. Enter the mode of intake.

For inhalation, enter 'H.'

For absorption through the skin, enter 'B.'

For oral ingestion.

enter 'G. ' For injection, enter 'J."

1 OD. Enter the Intake of each radionuclide in pCi.

11.

Enter the deep dose squivalent (DDE) to the whole body.

12.

Enter the eye dose equivalent (LDE) recorded for the lens of the aye.

13.

Enter the shallow dose equivalent recorded for the skin of the whole body (SDE.WB).

14.

Enter the shallow dose equivalent recorded for the skin of the extremity receiving the maximnum dose ISDEMEI.

15.

Enter the committed effective doss equivalent ICEDEI or

'NR' for 'Not Required' or 'NC' for 'Not Caiculated'.

16.

Enter the committed dose equivalent ICDEI recorded for the msxsmally exposed organ or 'NR' for 'Not Required' or

'NC' for 'Not Cdlculated'.

17.

Enter the total effective dose equivalent ITEDEI. The TEDE is the sum of items 11 and 15.

18.

Enter the total organ dose equivalent (TODE) for the maximally exposed organ. The TODE is the sum of items 11 and 16.

0o

4.

Check the box that denotes the sex of the Individual being monitored.

S.

Enter the date of birth of the individual being monitored in the format MM/DD/YY.

6.

Enter the monitoring period for which this report is filed. The format should be MM/DD/YY - MM/DD/YY.

7.

Enter the name of the licensee.

8.

Enter the NRC license number or numbers.

9A.

Place an 'X' in Record or Estkmate. Choose 'Record, if the does data listed represent a final determination of the dose received to the best of the licensees knowledge. Choose 'Estimsta' only if the listed dose data re preliminary and wili be supersaded by a final determination resulting in a subsequent report.

An example of such an instance would be dose data based on self-reading dosimeter results and the licensaee intends to assign the record dose on the basis of TLD results that are not yet avaiable.

98.

Plece an 'X' in either Routine or PSE.

Choose

'Routine-ifthedatarepresenttheresufteofmonitong for routine exposures. Choose 'PSE' if the Ibted dose data represents the results of monitoring of planned special exposures received during the monitoring Pursuant TO 5 U.S.C. 552a/eli31, enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579), the following statement is furnished to individuals who supply information to the U.S. Nuclear Regulatory Commission on NRC Form 5.

This information is maintained in a system of records designated as NRC-27 and described at 55 Federal Register 33984 (August 20.

1990), or the most recent Federal Register publication of the Nuclear Regulatory Commission's 'Republication of Systems of Records Notices' that Is available at the NRC Public Document Room, Gelman Building, Lower Lv. 2120 L Street NW, Washington, D.C.

1.

AUTHORITY:

Sections 53. 63, 65, 81, 103. 104, 161(b), and 161101 of the Atomic Energy Act of 1954, as amended 142 U.S.C 2073, 2093.

2095. 2111. 2133. 2134, 2201 lb), and 2201(o)).

The authority for soliciting the social security number is 10 CFR Part 20.

2.

PRINCIPAL PURPOSEIS):

The information is used by the NRC in its evaluation of the risk of radiation exposure associated with the licensed activity and in exercising its statutory responsibility to monitor and regulate the safety and health practices of its licensees. The dote permits a meaningful comparison of both current end long-term exposure experience among types of licensees and among licensees within each type.

Data on your exposure to radietion is available to you upon your request.

3.

ROUTINE USE(S):

The information may be used to provide data to other Federal nd State agencies involved in monitoring and/or evaluating radiation exposure received by individuals employed as radiation workers on a permanent or temporary basis and exposure received by monitored visitors The information may also be disclosed to an appropriate Federal.

State. or local agency in the event the information indicates a violation or potential violation of lew and in the course of an administrative or judicial proceeding.

4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDINt INFORMATION: it is voluntary that you furnish the requested information, including social tecurity number; however, the licensee must complete NRC Form 5 on each individual for whom personnel monitoring is required under 10 CFR 20.2106. Failure to do so may subject the licensee to enforcement action in accordance with 10 CFR 20.2401.

The social security number is used to assure that NRC has an accurate identifier not subject to the coincidence of similar names or birthdates among the large number of persons on whom data is maintained.

5.

SYSTEM MANAGERIS) AND ADDRESS:

REIRS Project Manager Oflice of Nuclear Regulatory Research U.S. Nuclear Regulatory Commission, Washington, DC 20555 is.

20.

21.~

Signature of the person designated to represent the licensee.

Enter the date this form was prepared.

COMMENTS.

In the space provided, enter additional information that might be needed to determine compliance with limits. An example might be to enter the note that the SDEME was the result of exposure from a discrete hot particle. Another possibility would be to indicate that an overexposed report has been sent to NRC in reference to the exposure report.

11

APPENDIX A FORMAT FOR ELECTRONIC TRANSMISSION OF EXPOSURE DATA Introduction 0

File name The following outlines a means by which licensees may satisfy the requirements, of 10 CFR 20.2206, "Reports of Individual Monitoring," in an electronic format by submitting magnetic disks, cartridges, or tape with formatted radiation exposure data.

Media Requirements The following data storage media are compatible with the Radiation Exposure Information Reporting Sys-tem (REIRS). The electronic media listed below are preferred by NRC for these submissions and are pre-sented in the order of preference. However, licensees are encouraged to submit data on whatever system is compatible with their existing systems. Other forms of data submission may also be acceptable. NRC will provide additional guidance to licensees upon request to the REIRS Project Manager.

PC Diskettes Date Created Operating system Contact Other instructions Signature and date Descriptive name of the file or files contained on the disk.

Date each file was cre-ated.

Operating system and version used to format the disk.

Name and telephone number of the person knowledgeable about each file.

Comments or explana-tion regarding the sub-mission, the actual date, the data format, or the other important infor-mation.

Dated signature of the licensee's authorized representative responsi-ble for the data.

32" or 5%$"

Double sided, high or double density Standard IBM-DOS format ASCII character format Magnetic Tape 8 mm tape cartridges Data quality ASCII or EBCDIC format Transmittal Letters With the submission of each disk, tape, or cartridge, the licensee should also submit a transmittal letter containing information that will minimize processing time and help resolve possible discrepancies. Each letter should contain the following information as a minimum:

Expected Data One routine Form 5 is expected for each monitored individual at the facility for the monitoring year.

There may also be a Form 5 for a planned special exposure for some individuals. Because there should be few repetitions of employee information, the em-ployee information is included in the Form 5. The primary license number is also included in each Form 5 to ensure that the records are assigned to the proper facility.

File Structure The file structure consists of a Header Record, which provides information about the source of the data file, followed by Form 5 dose records and supporting Form 5 intake records. Each record contains only ASCII or EBCDIC printable characters and is termi-nated with a Carriage Return (CR) and a Line Feed (LF). All empty space in a field is padded with spaces. Text strings are expected to be left justified in a field and numbers are expected to be right justified in a field.

8.7-9

Header Record The following record type occurs only once at the top of each data file to identify the source of the data.

Start End Field Width Col.

Col.

Description PrimaryLicense 13 1

13 Primary NRC license number.

PreparationDate 8

15 22 Date the record was written to the data file formatted as 'YYYYMMDD.'

LicenseeName 72 24 95 Name of NRC licensee.

Contact 72 97 168 Name of person to contact for further information about this data file.

PhoneNumber 14 170 183 Contact's phone number.

OtherLicense-1 13 185 197 Other related NRC license numbers.

OtherLicense 2 13 199 211 Other related NRC license numbers.

OtherLicense_3 13 213 225 Other related NRC license numbers.

OtherLicense_4 13 227 239 Other related NRC license numbers.

OtherLicense 5 13 241 253 Other related NRC license numbers.

OtherLicense_6 13 255 267 Other related NRC license numbers.

OtherLicense 7 13 269 281 Other related NRC license numbers.

OtherLicense 8 13 283 295 Other related NRC license numbers.

OtherLicense 9 13 297 309 Other related NRC license numbers.

OtherLicense_10 13 311 323 Other related NRC license numbers.

8.7-10

Form 5 Dose Record The following record type occurs once for each Form 5 being reported. It is followed by zero or more Form 5 Intake Records.

Start End Field Width Col.

Col.

Description Employee_ID 12 1

12 SSN, PPN, CSI, WPN, IND, or OTH.

IDs should have no punctuation.

ID Type 3

14 16

'SSN,' 'PPN,' 'CSI,' 'WPN,'

'IND,' or '0TH' PrimaryLicense 13 18 30 Primary NRC license number.

PreparationDate 8

32 39 Date the record was written to the data file formatted as 'YYYYMMDD.'

Record Type 1

41 41

'D' = DOSE FirstName 25 43 67 Employee's full first name (no nicknames).

Middle-Initial 1

69 69 Employee's middle initial.

LastName 25 71 95 Employee's last name. Titles such as "Jr" should be separated from the last name by a space. No punctuation should be used in the title.

Sex 1

97 97 Employee's sex.

'M' = Male and 'F' = Female BirthDate 8

99

'106 Employee's date of birth

('YYYYMMDD').

Monitoring Start 8

108 115 Date monitoring began

('YYYYMMDD'). This is typically January 1 of the monitoring year for everyone except new hires.

MonitoringEnd 8

117 124 Date monitoring ended

('YYYYMMDD').

This is typically December 31 of the monitoring year for everyone except terminations.

Report Type 1

126 126

'R' = Record, or 'E' = Estimate Exposure Type 1

128 128

'R' = Routine, or 'P' = PSE 8.7-11

Start End Field Width Col.

Col.

Description DDE 8

130 137 Deep dose equivalent in rems. This can be formatted as '999.999.'

LDE 8

139 146 Eye dose equivalent to the lens of the eye in rems. This can be formatted as

,999 999,1 SDEWB 8

148 155 Shallow dose equivalent, whole body in rems. This can be formatted as '999.999.'

SDEME 8

157 164 Shallow dose equivalent, max extremity in rems. This can be formatted as '999.999.'

CEDE 8

166 173 Committed effective dose equivalent in rems. This can be formatted as '999.999.'

CDE 8

175 182 Committed dose equivalent. This can be formatted as '999.999.'

TEDE 8

184 191 Total effective dose equivalent. This can be formatted as '999.999.'

TODE 8

193 200 Total organ dose equivalent, maximally exposed. This can be formatted as '999.999.'

8.7-12

Form 5 Intake Record The following record should be provided for each intake on the Form 5 being reported.

Start End Field Width Col.

Col.

Description EmployeeID 12 1

12 IDs should have no punctuation.

ID-Type 3

14 16

'SSN,' 'PPN,' 'CSI,' 'WPN,' 'IDL,' 'IND,' or

'OTH.'

PrimaryLicense 13 18 30 Primary NRC license number.

Preparation-Date 8

32 39 This is the date from the parent Form 5 Dose Record formatted as 'YYYYMMDD.'

Record-Type 1

41 41

'I' = Intake Radionuclide 9

43 51 Radionuclide abbreviation with the hyphen.

Class 1

53 53

'D,' 'Y,' 'W,' 'V,' or 'O' for other.

Mode 1

55 55

'H' = Inhalation, 'B' = Absorption, 'J'.=

Injection, 'G' = Ingestion Intake 10 57 66 The amount of gCi for the radionuclide.

This can be expressed in scientific notation using the format '+9.999E+99' or as a decimal number of less than 9 digits.

8.7-13

Form 5 Comment Record The following record type occurs only overexposures.

when comments are necessary to explain special exposure calculations or Start End Field Width Col.

Col.

Description Employee ID 12 1

12 IDs should have no punctuation.

ID-Type 3

14 16

'SSN,' 'PPN,' 'CSI,' 'WPN,' 'IDL,' 'IND,' or

'OTH.'

PrimaryLicense 13 18 30 Primary NRC license number.

PreparationDate 8

32 39 This is the date from the parent Form 5 Dose Record formatted as 'YYYYMMDD.'

Record-Type 1

41 41

'C' = Comment Comment 240 43 282 Explanatory comment when needed.

8.7-14

REGULATORY ANALYSIS A separate regulatory analysis was not prepared for this regulatory guide. The regulatory analysis prepared for 10 CFR Part 20, "Standards for Protection Against Radiation" (56 FR 23360), pro-vides the regulatory basis for this guide and examines the costs and benefits of the rule as implemented by the guide. A copy of the "Regulatory Analysis for the Revision of 10 CFR Part 20" (PNL-6712, November 1988), is available for inspection and copying for a fee at the NRC Public Document Room, 2120 L Street NW., Washington, DC, as an enclosure to Part 20.

8.7-15

UNITED STATES NUCLEAR REGULATORY COMMISSION WASHINGTON, D.C. 20555-0001 FIRST CLASS MAIL POSTAGE AND FEES PAID USNRC PERMIT NO. G-67 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE, $300