ARFQ DCR2500000066 - Exhibit C - NRC Form 5.pdf

This is an NRC Form 5 exhibit document related to a government contract opportunity (GovTribe ID: b53fc01d81e9823055bca4ebd7bf624a) managed under ARFQ DCR2500000066. The form is a regulatory compliance document used for tracking radioactive material intake and related information. The form captures essential identification data including the subject's name, identification number, date of birth, and licensee information. It includes structured fields for recording multiple radionuclide entries with associated classifications, modes of intake, and measured intake values in Curies (Ci). The document contains designated spaces for up to twelve separate radionuclide records, allowing comprehensive documentation of radioactive exposure or intake events. Required signature and date preparation fields are included for licensee authorization and documentation purposes.

The NRC Form 5 serves as a standardized reporting mechanism for nuclear regulatory compliance and occupational health monitoring. No specific pricing terms, contract amounts, set-asides, or funding information is contained within this form. This document functions as a supporting exhibit within the broader contract opportunity package and appears designed for administrative and regulatory record-keeping related to nuclear material handling and worker safety monitoring requirements.