NRC Form 5 – Occupational Dose Record for a Monitoring Period

Form Number: NRC Form 5
Form Title: Occupational Dose Record for a Monitoring Period
Current Edition: 01-2021
Authority Directive or Regulation: 10 CFR Part 20
Form Status: Approved by OMB: 3150-0006, Expires: 01/31/2024
Special Instructions:

Instructions and additional information pertinent to the completion of this form are on Page 2 of the form.

For Questions:

E-mail:  Minh-Thuy.Nguyen@nrc.gov RES/DSA/RPB

Telephone Number: (301) 415-5163

Page Last Reviewed/Updated Wednesday, January 20, 2021