Please indicate the specific unused dosimeter being reassigned below (both name on the dosimeter and the dosimeter number starting with XA or BA located on the back of the dosimeter). Please provide details regarding the individual the dosimeter should be transferred: Name, ID (if applicable), Date of Birth (if applicable). Finally, please confirm in writing that “The dosimeter being transferred has not been used at our facility” before submitting this form. we do not receive written confirmation that the dosimeter was not used, the request will not be processed.
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