Title: RTF Template
Author: MACDONALD, Jennifer
Last saved by: Stanislava Bystricka
Document comments: Generated by Oracle XML Publisher 5.6.3

OCCUPATIONAL EXPOSURE HISTORY (OEH) FORM
Candidate’s Name |
Employer |

Event Title | Interregional Training Course on Human Resource Management for New and Expanding Nuclear Power Programmes
Event Reference | TN-INT2021-2301340
Venue | Lowell (MA), United States of America
Dates | From: 22 April 2024                To: 26 April 2024

Are you covered under an individual monitoring programme in your country?    □ YES   □ NO
If yes, 
•	Starting date of the individual monitoring (mm/yyyy): 	
•	please fill in the applicable fields below:

Quantity

Unit reported

Value during the previous 
five calendar years

Value during the current calendar year

Effective dose(1) | | |
Equivalent dose to the lens of the eyes | | |
Equivalent dose to the extremities or to the skin | | |

OEH data provided or confirmed by(2):

Name: 	
Responsibility: 	
Signature:

Candidate’s Signature: 		Date(3): 	
 (1) Effective dose due to external AND internal exposure. If another quantity is reported, please indicate name and unit.
(2) The OEH data is to be provided or confirmed by the radiation protection officer, the candidate’s supervisor, or the provider of the individual monitoring service.
(3) This form should not be older than six months before the date of the event.