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Appendix M

Appendix M

Notification of Nuclear Energy Worker Status

Notification of nuclear energy worker status
[rad_manual_appendixM_notification.pdf - PDF - 71.92 KB]
Form to be filled out in by an energy worker status according to the McGill Radiation Safety Policy Manual

Worker:
Sex: M / F
Date of Birth:
SIN Number:

In accordance with the Nuclear Safety and Control Act and Regulations of Canada, this is to inform you that you are a NUCLEAR ENERGY WORKER. A Nuclear Energy Worker as defined in the Nuclear Safety and Control Act means a person who is required, in the course of the person's business, or occupation in connection with a nuclear substance or nuclear facility to perform duties in such circumstances that there is a reasonable probability that the person may receive a dose of radiation that is greater than the prescribed limit for the general public.

As required by the Radiation Protection Regulations (RPR), I have been informed in writing of:

  • the risks associated with radiation to which I may be exposed during the course of my work, including the risk associated with the exposure of an embryo and foetus;
  • the applicable dose limits as specified in the RPR;
  • my expected radiation dose levels;
  • for females, my rights and obligations should I become pregnant.

I understand the risks, my obligations, and the radiation dose limits and levels that are associated with being designated a NEW.

Signature of Worker
Signature of RSO
Date