410 IAC 5-4-3 Disclosure of prior exposure; certification for excess exposure (form Y)

Sec. 3. (a)(1) Each licensee or registrant shall require any individual, prior to first entry of the individual into the licensee's or registrant's restricted area during each employment or work assignment under such circumstances that the individual will receive or is likely to receive in any period of 1 calendar quarter an occupational dose in excess of 25 percent of the applicable standards specified in 410 IAC 5-4-2(a) and 410 IAC 5-4-5(a), to disclose in a written, signed statement, either: (i) That the individual had no prior occupational dose during the current calendar quarter, or (ii) The nature and amount of any occupational dose which the individual may have received during the specifically identified current calendar quarter, from sources of radiation possessed or controlled by other persons. (2) Each licensee or registrant shall maintain records of such statements until the board authorizes disposition. (b) Before permitting, pursuant to 410 IAC 5-4-2(b), any individual in a restricted area to receive an occupational radiation dose in excess of the standards specified in 410 IAC 5-4-2(a), each licensee or registrant shall: (1) obtain a certificate on board form "Y" or on a clear and legible record containing all the information required in that form, signed by the individual, showing each period of time after the individual attained the age of 18 in which the individual received an occupational dose of radiation; and (2) calculate on board form "Y" in accordance with the instructions appearing therein, or on a clear and legible record containing all the information required in that form, the previously accumulated occupational dose received by the individual and the additional dose allowed for that individual under 410 IAC 5-4-2(b). (c)(1) In the preparation of board form "Y," or a clear and legible record containing all the information required in that form, the licensee or registrant shall make a reasonable effort to obtain reports of the individual's previously accumulated occupational dose. For each period for which the licensee or registrant obtains such reports, he shall use the dose shown in the report in preparing the form. In any case where a licensee or registrant is unable to obtain reports of the individual's occupational dose for a previous complete calendar quarter, it shall be assumed that the individual has received the occupational dose specified in whichever of the following columns that apply: Column 1 Column 2 Part of Body Assumed Dose in Rems for Calendar Quarters Prior to January 1, 1961 Assumed Dose in Rems for Calendar Quarters Beginning on or After January 1, 1961 Whole body, gonads, active blood-forming organs, head and trunk, lens of eye 3 3/4 1 1/4 (2) The licensee or registrant shall retain and preserve records used in preparing board form "Y" until the board authorizes their disposition. If calculation of the individual's accumulated occupational dose for all periods prior to January 1, 1961, yields a result higher than the applicable accumulated dose value for the individual as of that date, as specified in 410 IAC 5-4-2(b)(2), the excess may be disregarded.