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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 |