PWS Attachment 14 RFP 75N98020R00014.xls
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- Radiation Safety Services
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- 75N98020R00014
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Front
| Laboratory Security Surveillance Report | |||||||
| Health Physicist: Date: | |||||||
| Locations Surveyed | Violation | Other √ | Floor Start/Stop Time | ||||
| Building | Suffix | Floor | Yes | No | Military Time | Military Time | |
| General Comments: | |||||||
| Violation Other Access gained by: | Door Open Adjoining Lab Open Lock Taped Lock Broken Door Locked/Not Latched Other:_____________________ | ||||||
| Building | Suffix | Floor | Wing | Room | Suffix | Time Noted | |
| Additional Areas Reported on Reverse Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Authorized User:________________________________DRS#_____________ |
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| PWS Attachment 14 Laboratory Security Surveillance Report | ||||||
| Health Physicist: Date: | ||||||
| Building | Suffix | Floor | Wing | Room | Suffix | Time Noted |
| Violation Other Access gained by: | Door Open Adjoining Lab Open Lock Taped Lock Broken Door Locked/Not Latched Other____________________ | |||||
| Comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Authorized User:________________________________DRS#_____________ | ||||||
| Building | Suffix | Floor | Wing | Room | Suffix | Time Noted |
| Violation Other Access gained by: | Door Open Adjoining Lab Open Lock Taped Lock Broken Door Locked/Not Latched Other____________________ | |||||
| Comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Authorized User:________________________________DRS#_____________ | ||||||
| Building | Suffix | Floor | Wing | Room | Suffix | Time Noted |
| Violation Other Access gained by: | Door Open Adjoining Lab Open Lock Taped Lock Broken Door Locked/Not Latched Other____________________ | |||||
| Comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Authorized User:________________________________DRS#_____________ | ||||||
| Building | Suffix | Floor | Wing | Room | Suffix | Time Noted |
| Violation Other Access gained by: | Door Open Adjoining Lab Open Lock Taped Lock Broken Door Locked/Not Latched Other____________________ | |||||
| Comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Authorized User:________________________________DRS#_____________ |
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