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Current REP Forms

Below you will find the current forms being used by the Radiological Emergency Preparedness Program.

If you have any questions or concerns, please feel free to contact NH Homeland Security and Emergency Management Radiological Emergency Preparedness at (603) 271-2231 or rep@dos.nh.gov.

Name Code
305A Dosimetry-KI Report Form (multi-part) (packet) NO16
Emergency Worker Information Job Aid FE18
F110D Local Transportation Request from Special Facilities/Individuals FE18
F120A Chronological Event Log FE18
F120G Message Controller’s Log FE18
F120L Dosimetry Log Sheet FE18
F120R Local Transportation Staging Area Vehicle Log FE18
F120T Sign In Sheet FE18
F135A Potassium Iodide (KI) Acknowledgement Form FE18
F205G Local Emergency Response Message Form FE18
F300A Emergency Worker Cumulative Exposure Report FE18
F300B Status Report – Seabrook Station FE18
F300Y Individual Cumulative Exposure Report FE18
Geiger Muller Survey Instruments Information Sheets FE17
Host Facility Background Job Aid FE17
Host RADEF Officer Briefing Card FE17
Operational Checks for Dosimetry Job Aid FE18
Personnel Monitoring Job Aid FE17
RADAlert 100X Background Radiation Detection EPZ Job Aid MA16
RADEF Officer Briefing Card FE18
Staging Area RADEF Briefing Card FE18

 

EPZ

Name Code
Emergency Worker Information Job Aid FE18
EPZ RADEF Briefing Card FE18
F110D-Local Transportation Requests from Special Facilities and Individuals FE18
F120A Chronological Event Log FE18
F120G Message Controller’s Log FE18
F120R Local Transportation Staging Area Vehicle Log FE18
F120T Sign-in Sheet FE18
F135A Potassium Iodide Acknowledgement Form FE18
F205G Local Emergency Response Message Form FE18
F300A Emergency Worker Cumulative Exposure Report FE18
Geiger Muller Survey Instruments Used For Background Detection In EPZ FEB18
RADAlert 100x Job Aid MA16


Host

Name Code
300P Personnel Radiological Monitoring Report Form FE18
F103A Welcome to the Reception Center FE17
F120K Emergency Vehicle Monitoring Report Form FE17
F300Q Contaminated Personal Belongings List FE18
Geiger Muller Survey Instruments for Contamination Detection FE17
Host Facility Background Job Aid FE17
Host RADEF Briefing Card FE17
Personnel Monitoring Job Aid FE17


STSA

Name
F110A Transportation Resource Requests (Seabrook Station)
F110F 8×11 Transportation Resources Chart
F120N Transportation Log
F125A Vehicle Assignment Form
F125B Dispatch Order
F125C Vehicle Registration
F125D Vehicle Arrival Report
F125H Transit Vehicle Log Sheet
F300H EMS Transportation Resources Status Report/ Summary Sheet
F301A Current Inventory Board (Seabrook Station)