Table I.1, Dosimetry Evaluation

Dosimetry Evaluation for _________________ Model _____________ Portable Gauge
A. Time needed to perform the entire routine cleaning and lubrication procedure on the gauge ___________minutes/60 ___________hour
B. Expected whole body dose rate which the individual will encounter, determined using measured or manufacturer-provided data. ___________mrem/hr
C. Time the hands were exposed to the unshielded source ___________minutes/60 ___________hour
D. Expected extremity dose rate which the individual will encounter, determined using measured or manufacturer-provided data for the unshielded source at the typical distance from the hands to the unshielded source. ___________mrem/hr
Formula: (_____#hours in Row A) x (______mrem/hr in Row B) = (_____estimated mrem) x (_____# of clean and lubrications conducted each year) = _______ mrem *Whole Body Dose Equivalent
Formula: (_____#hours in Row C) x (______mrem/hr in Row D) = (_____estimated mrem) x (_____# of clean and lubrications conducted each year) = _______ mrem **Extremity Dose Equivalent
*Whole Body Dose Equivalent less than 500 mrem requires no dosimetry

**Extemity Dose Equivalent less than 5000 mrem requires no dosimetry