ARFQ DCR2500000083 - Exhibit C - NRC Form 5.pdf

This document is an NRC Form 5, a regulatory form used by the Nuclear Regulatory Commission (NRC) for tracking occupational radiation exposure. The form is designed to record individual radiation dosimetry information for workers at licensed nuclear facilities. The form captures personal identification data including name, identification number, identification type, and date of birth, along with licensee information and license numbers. The primary focus of the form involves documenting radionuclide exposure data across multiple rows, with fields for recording the radionuclide type, classification, intake mode, and intake measurement in curies (Ci) for each exposure incident. The form provides 12 rows for recording separate radionuclide intake events, allowing for comprehensive tracking of an individual worker's radiation exposure history.

The form includes fields for comments related to the documented exposures and requires signatures from the licensee along with the date the form was prepared. This NRC Form 5 serves as an official record-keeping document required for regulatory compliance and occupational health and safety purposes at nuclear facilities. The document represents a standardized reporting mechanism used across the nuclear industry to maintain detailed exposure records that can be reviewed by the NRC and other regulatory bodies to ensure worker safety standards are met and exposure limits are not exceeded.