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) | |
