PWS_Attachment_14_-_Laboratory_Security_Surveillance_Report.pdf

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Regulatory Compliance and Radiation Safety Support
Solicitation number
NIHOD2015053
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PWS Attachment 14 - Laboratory Security Surveillance Report

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Building Suffix Floor Wing Room Suffix

Building Suffix Floor Wing Room Suffix

Building Suffix Floor Wing Room Suffix

Building Suffix Floor Wing Room Suffix

Door Open Adjoining Lab Open Lock Taped Lock Broken Door

Locked/Not Latched Other____________________

Time Noted

Laboratory Security Surveillance Report

Health Physicist: Date:

Time Noted

Comments:

____Authorized User:________________________________DRS#_____________

Violation Other Access gained by:

Door Open Adjoining Lab Open Lock Taped Lock Broken Door

Locked/Not Latched Other____________________

____Authorized User:________________________________DRS#_____________

____Authorized User:________________________________DRS#_____________

____Authorized User:________________________________DRS#_____________

Violation Other Access gained by:

Door Open Adjoining Lab Open Lock Taped Lock Broken Door

Locked/Not Latched Other____________________

Violation Other Access gained by:

Door Open Adjoining Lab Open Lock Taped Lock Broken Door

Locked/Not Latched Other____________________

Violation Other Access gained by:

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