Figure 1. Sample requisition.

SB 11-206

(Letterhead of requisitioning activity)

SUBJECT: Initial Requisition for Film Badge Service

TO: Chief, US Army Ionizing Radiation Deosimetry Center, ATTN: DRXTM-CI-DCS, Lexington, Kentucky 40511

1. Request that film badge service be furnished for the following 90 named individuals, 5 visitors, and 2 spares:

Serial

Name

SSN

DOB

Radiation

001

King, Joseph M.

432-56-9492

20 Aug 55

90Sr90Y

002

Abney, A. E.

349-20-3251

16 May 46

60Co, 137Cs

003

Stevenson, Janet

423-56-7839

2 Feb 50

90 kVp x-ray

004

Jones, James

357-49-1 129

3 Oct 43

30 kVp x-ray

etc...................... etc .................... etc ...................... etc...................... etc ..................... etc ......................etc

091-095-Visitors ...............................................................................................................................................

096-097-Spares ...............................................................................................................................................

2. Send holders, original and subsequent film packets, and dosage readings to: (address and attention line of

requisitioning activity.)

3. Emergency telephone contact from 0800 through 1700 hours during working days is: (Name or title of individual,

telephone and extension numbers.)

At other times: Duty Officer (telephone and extension numbers).

Figure 1. Sample requisition.