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CLASSE Radiation Badge Mishap Form
Please enter the requested information related to the badge mishap being reported.
You will need to hit your tab key or click on the form space before entering information from the keyboard, or click on the answer itself (the word or the open circle next to it) to choose answer(s) from a selection.
When done with any page, advance to the next one by clicking on the Next>> button at the lower right of the window.
When you are done, a summary of the information entered will be sent to the appropriate persons, including the badge owner and the individual filling out this form, as well as the Radiation Support Specialist and Safety Director.
Thank you for your cooperation.
Badge-holder first name
Badge-holder last name
Date of original mishap (mm/dd/yyyy)
Approximate time of original mishap
Are you, the individual filling out this form, the badge-holder?
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