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Notice to  Employees  (PDF, 32 KB)

Occupational Exposure Record  (PDF, 89 KB)

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Radioactive Materials Licensing Notes

A. The pertinent paragraphs regarding this form are in Administrative Code DHS 157.88, Subchapter X,  #7, and are:

DHS 157.88 Posting, notification and reporting requirements. (1) POSTING OF NOTICES TO WORKERS. (a) Except as provided in par. (b), a licensee or registrant shall post current copies of all the following documents in a conspicuous location that is accessible to workers on the way to or from the worker’s work station or job location:

7. A "Notice to Employees" form that details the types of information that employers must give to their employees and department contact information.

Note: The "Notice to Employees" form may be obtained from the Department by writing: Department of Health Services, Radiation Protection Section, P.O. Box 2659, Madison WI 53701-2659.

This is a required form.  See DHS 157 (PDF, 717 KB, pg 415) or the unofficial version at Subchapter X


B. The pertinent paragraphs regarding this form are in Administrative Code DHS 157.88, Subchapter X,  #6, and are:

DHS 157.88 Posting, notification and reporting requirements. (1) POSTING OF NOTICES TO WORKERS. (a) Except as provided in par. (b), a licensee or registrant shall post current copies of all the following documents in a conspicuous location that is accessible to workers on the way to or from the worker’s work station or job location:

 6.  Emergency procedures that apply to activities conducted under the license or registration.

This is a required form.  See DHS 157 (PDF, 717 KB, pg 415) or the unofficial version at Subchapter X


C. The pertinent paragraphs regarding this form are in Administrative Code DHS 157.88, Subchapter X(3), and are:

(3) NOTIFICATIONS AND REPORTS TO INDIVIDUALS. (a) Radiation exposure reports. Every 12 months, a licensee or registrant shall provide a written report of radiation exposure to each employee who is required to be monitored for radiation exposure under s. DHS 157.25 (2). The report shall include all of the following:

1. Name of the licensee or registrant, the name of the individual and the individual’s identification number.

2. Results of any measurements, analyses and calculations of radioactive material deposited or retained in the body of the individual being monitored.

3. Any order issued under this chapter.

4. Any condition of the license or registration as shown in records maintained by the licensee or registrant under s. DHS 157.31 (7) that relates to radiation exposure of employees.

5. Each calendar quarter in which the worker's activities involved exposure to sources of radiation and the dates and locations of work. If a report under this paragraph is being provided to employees under par. (b) or (c), the report shall include the calendar quarter within which the employee terminates employment or requests a report under this subsection.

6. The radiation exposure report for each year the worker was required to be monitored under s. DHS 157.25 (2).

7. The statement: "This report is furnished to you under the provisions of Wisconsin Administrative Code, Chapter DHS 157, Radiation Protection. You should retain this report for future reference."

(b) Reports to employees upon termination. A licensee or registrant shall provide the report required under par. (a) to each employee within 30 days of the employee’s termination.

(c) Reports to employees upon request. A licensee or registrant shall provide an employee with the report required under par. (a) within 30 days of receiving a written request from the employee, or within 30 days after the dose of the individual has been determined by the licensee or registrant, whichever is later.

(d) Reports to the department. A licensee or registrant required to provide a report under s. DHS 157.32 (2) to (4) shall, on the same day, provide a copy of the report to the subject of the report.

(e) Exposure request at time of termination. At the request of a licensee’s or registrant’s employee or of a worker employed by another person but working in a licensee’s or registrant’s facility, a licensee or registrant shall, upon a worker’s termination, provide to the worker, or to the worker’s designee, a written report of the radiation dose received by that worker from operations of the licensee or registrant during the current calendar quarter or fraction thereof. If the most recent individual monitoring results are not available at that time, a licensee or registrant shall provide a written estimate of the dose, clearly indicating that it is an estimate. 

(f) Documentation required to be maintained. Documentation that a report was provided as required under this subsection shall be maintained by the licensee or registrant for 3 years after generation of the documentation.

This is a required form.  See DHS 157 (PDF, 717 KB, pg 415) or the unofficial version at Subchapter X


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Last Revised:  July 02, 2014