OSL Per sonnel Monitoring Ser vice

U se r Wo r k In str uc tion s
W I - 5 . 4 . 1 R e v. 1 ( 2 0 1 3 )

Radiation Protection Services

Ph il i pp in e Nu c le ar R e se arc h In s ti tu t e

WI-5.4.1 Rev.1 (2013) 1

 Table of Contents

Content Page

1. The Purpose of the Service Guide ------- 3

2. OSL Personnel Monitoring Service Overview ------- 3

3. Subscribing to the Service ------- 6
3.1. Subscription Options ------- 6
3.2. Application for Subscription ------- 6
3.3. Selection of Individuals to be Monitored ------- 7
3.4. Frequency of Monitoring Period ------- 8

4. OSL Personnel Monitoring Service Processes ------- 9

4.1. Application of the client for the service ------- 9
4.2. Preparation & Issuance of the OSL dosimeters ------- 9
4.3. Wearing of the OSL dosimeters during work ------- 10
4.4. Return of the OSL dosimeters ------- 10
4.5. Processing & evaluation the dosimeters ------- 11
4.6. Making of dose evaluation reports ------- 11

5. Using your OSL dosimeters ------- 14

5.1. OSL dosimeter main components ------- 14
5.2. Your dosimeter package ------- 15
5.3. Using your OSL dosimeter ------- 15
5.4. Storing & caring for your dosimeters ------- 17
5.5. Records keeping ------- 18

7. References ------- 19
Appendices
A: Application Form ------- 20
B: Memorandum of Agreement (MOA) ------- 22
C. Personal Identification Sheet ------- 24
D. Personal Dose Monitoring Report ------- 25

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1. The Purpose of the Service Guide
The purpose of this booklet is to guide the clients of the Radiation
Protection Services (RPS) to its Optically Stimulated
Luminescence (OSL) Personnel Monitoring Services. Discussed in
this guide are the a) steps in availing of the service, b) OSL
dosimetry service processes, c) instructions in using & caring for
the OSL dosimeters and d) overview of OSL dosimeter system &
personnel monitoring programs.

2. OSL Personnel Monitoring Service Overview

The Philippine Nuclear Research Institute through the Radiation
Proctection Services has been providing technical services to
licensed users of ionizing radiation to support them in their
compliance to the radiation safety requirements of the national
regulatory authorities.
Since the 1970s, the RPS has been
“PNRI thru RPS providing radiation safety services such as
has been providing a) occupational radiation protection
radiation safety services, b) area monitoring of licensed
services since the facilities, c) calibration & dosimetry
1970s.” services through its Secondary Standards
Dosimetry Laboratory (SSDL), d)
radiation control services, e) radioactive
waste management and f) response to radiological & nuclear
emergencies. Our clientele are composed of at least 5,000
government and private institutions.
Exposure to ionizing radiation could be a health hazard. Personnel
working with ionizing radiation may be exposed to sources that are
both inside and outside their bodies. Personal doses therefore
need to be measured & assessed in order to demonstrate safety
of personnel and readily identify overexposures to radiation.

RPS has been providing personnel monitoring services to

occupationally exposed workers in the Philippines to enable
workers to monitor their radiation exposures and ensure that their
workplace is safe. It is part of PNRI’s commitment to strengthen
the occupational radiation safety by providing sustainable &
reliable personnel monitoring services.

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 RPS prepares &
issues the OSL
dosimeters

Clients apply for Workers wear the OSL

subscription to the dosimeter while working
OSL personnel with radiation
monitoring service

RPS gives the personal Clients return the

dose monitoring report OSLs after the
to the client Monitoring Period

RPS processes &

evaluates the doses
received

Figure 1. OSL Personnel Monitoring Service Cycle

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Currently, the RPS is providing the OSL Personnel Monitoring
Service. This new Dosimeter system makes use of the Optically
Stimulated Luminescence (OSL) Dosimeters. This new service is
provided as an upgrade from and replacement to the Filmbadge
dosimeter system. This OSL system, which was adopted to
enhance the personnel monitoring services, is more
technologically advanced in terms of accuracy, handling, and
evaluation of exposures received by personnel.

Figure 1 shows the overview of the OSL Personnel Monitoring

Service cycle. It illustrates the different processes in the service
from application, issuance, evaluation and releasing of dose
report. A detailed discussion of each process is found on Section
4.

Contact Us
Our office is available from Monday to Friday, from 8:30 to 17:00
by:
Phone: 9296011 local 262 & 246
Fax: 9201646
Email: [email protected]
Post: Radiation Protection Services Unit
Philippine Nuclear Research Institute
Commonwealth Ave., Diliman
Quezon City 1101 PHILIPPINES
P.O. Box: 213 at UP Quezon City
932 at Manila
1314 at Central, Quezon City

You may download our forms at

http://www.pnri.dost.gov.ph/pnri.php?pnri=forms
under the Radiation Protection Services

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3. Subscribing to the Service

3.1. Subscription Options

Clients can choose between two options for the OSL personnel
monitoring service. In Option 1, the PNRI owns and provides the
dosimeters. In Option 2, clients buy their own OSL dosimeters and
sends it to PNRI for initial processing & evaluation.

Option 1: PNRI provides the dosimeters

“Clients have two In this option, the OSL Dosimeters issued
subscription options to the clients are owned by PNRI. The
for the OSL dosimeters issued are to be used for an
personnel
monitoring service.” indicated monitoring period (MP). After
each MP, the dosimeters have to be
RETURNED to PNRI for processing &
evaluation.
Note that before subscription, the client shall sign a Memorandum
of Agreement (MOA) with PNRI on the terms & conditions of the
Service. The cost of the service for this option is
PhP160/dosimeter.

Option 2: Client buys or rents their own OSL Dosimeter

In this option, the client may RENT or PURCHASE their own OSL
dosimeters from authorized suppliers & use it for personnel
monitoring. The Dosimeters are therefore owned by the client.
Note that for this option the client has to send the dosimeters to
PNRI BEFORE each MP for initial processing and AFTER each
MP for dose evaluation of exposures received.
The cost of the Dose evaluation service is PhP160/dosimeter.
The client can bring the dosimeter to PNRI & get it back on the
same day.

3.2. Application for Subcription

The first step in the OSL personnel monitoring service, as

illustrated in Figure 1, is the application for subscription to the
service.
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 New NO New NO
Client Client

YES YES
Accomplish Accomplish
Application Form Application Form
(Appendix A) (Appendix A)

Correct NO Correct NO
info? info?

YES YES

Accomplish Client submits their

Memorandum of OSL dosimeters to
Agreement (MOA, RPS for initial dose
Appendix B) processing

Assessment & Assessment &

Payment of Fees Payment of Fees

Prepare OSL Dosimeters Prepare OSL Dosimeters

for Issuance for Issuance

Figure 2. Application process for OPTION 1

(left) and OPTION 2 (right) of the service

The application process depends on the option chosen. Figure 2

describes these steps.

3.3. Selection of Individuals to be Monitored

It is not necessary to monitor the exposures received of all the

workers in a radiation facility. Only those who are authorized in the
use and/or handling of the radiation sources are to be monitored.
In particular, these personnel to be monitored are:

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a) Individuals working in Controlled
Areas* “Individuals to be
b) Workers who are regularly employed monitored must be
in a Supervised Area or who enters a authorized users
or under
Controlled Area occasionally
supervision !!”
c) Declared pregnant workers who are
likely to receive an equivalent dose
from external sources to the
embryo/fetus in excess of the public limit of 1 mSv in a year
d) Emergency workers responding to a radiological incident or
emergency
e) Apprentices, students & trainees of age 16 years and above
who are training for employment involving exposure to
radiation and/or requried to use sources of ionizing radiation in
the course of their training/activities.
During application for subscription to the OSL service, supporting
documents demonstrating that the person to be monitored is
authorized and/or would be under supervision while using sources
of ionizing radiation must be presented to the RPS.
*For more details on classification of areas, refer to Ref 6

3.4. Frequency of Monitoring Period

The OSL dosimeters are passive devices that measure cumulative

radiation doses over a time period called the Monitoring Period
(MP). The MP is therefore the duration for which the dosimeters
will be used.
After each MP, the OSL dosimeters are returned by the client for
evaluation. The used dosimeters are then replaced or re-issued for
use on the next MP.
The frequency of this dosimeter exchange depends on the a)
magnitude of the potential radiation doses that maybe received
and b) possible fluctuations of exposure levels.
Typically, one MP is equivalent to two (2) months or 60 days.
However for practices with high exposure risks such as Industrial
Radiagraphy and Radiation Therapy practices, one MP is
equivalent to one (1) month.

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4. OSL Personnel Monitoring Service Processes
The daily activities of the RPS OSL service, as illustrated in Figure
1, is directed towards OSL processing & issuance as well as
evaluation of exposures results of the personnel.

In particular, the service has the

Preparation of the OSL following processes: 1. Client
dosimeters to be issued applies for subscription to the
service (discussed in Section 3), 2.
RPS prepares & issues the OSL
Initial dose processing
of the dosimeters dosimeters, 3. Workers wear the
dosimeters while working with
ionizing radiation, 4. Clients return
Entry of client & OSL the OSLs after the MP, 5. RPS
information into the database processes & evaluates the doses
received, 6. RPS provides the dose
evaluation report to the client. The
Printing of 2 copies Personal succeeding subsections discuss
Identification Sheet
(Appendix C) the processes in more detail.

4.1. Client applies for the OSL

Loading & labeling of the personnel monitoring service
dosimeters into the plastic
badge holder The application process for the
subcription to the OSL Personnel
Monitoring Service was discussed
Packing of the OSL in Section 3.
badges together with the
Personnel ID Sheet
4.2. RPS prepares & issues the
OSL dosimeters
Issuance OSL After the application process is
Dosimeters to the clients completed, the RPS starts the
preparation of the OSL dosimeters
for issuance to the client. Figure 3
Figure 3. Preparation &
shows the steps taken during the
Issuance of the OSLs to
preparation & issuance of the
the clients
dosimeters.

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4.3. Workers wear the dosimeters while working with ionizing
radiation
Upon receipt of the issued OSLs, the client
shall give the dosimeters to the assigned
individuals for them to wear while
working with radiation. The proper
use and wear practices es of the dosimeters are
detailed in Section 5.

4.4. Clients return the OSLs after the M

Monitoring Period

The monitoring period for which the OSL

dosimeters are to be used is indicated in the
Personal ID Sheet provided together with the
dosimeters. After each MP, clients should
RETURN to the RPS the used badges together
with the ID sheet for dose evaluation &
assessment.
OSL badges that are not returreturned or different
from the one in the ID sheet are noted and shall be indicated in the
dose evaluation report.
“Return the used
Badge Exchange / Re--issuance OSLs to RPS after
each MP for dose
Upon receipt of the used evaluation &
badges, the RPS will assessment!”
“Returned badges process the OSLs
will be RE-ISSUED immediately. After
for the next MP
w/in1-3 working days pro
processing, the OSL dosimeters will wil be
after date of return” Re
Re-ISSUED to the client to be used again by
the workers for the next MP.
Clients are expected to receive the re-issued
re
badges on the same day it was returned for walk
walk-in
in clients or at a
maximum of 3 working days for mailing clients.

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4.5. RPS processes & evaluates the doses received
Upon receipt, the used OSL
Receive used OSL badges are opened and removed
Badges from the badge holder. The
dosimeters are then prepared for
processing & evaluation. Figure 4
Remove OSL dosimeters
from the badge holder
shows steps during the processing
and evaluation of the OSL
dosimeters.
Process the dosimeters using
the OSL Reader After the dosimeters were
processed and readout, the
readings in terms of equivalent
Evaluate the doses received dose (in mSv) are transferred to
by the personnel using the
evaluation algorithm an evaluation worksheet to
calculate the total radiation doses
received by the personnel during
that monitoring period. The dose
Save the data in
preparation for the printing
results are then reviewed,
of dose reports assessed and compared to the
safe dose limits. After this step,
the data is saved in preparation for
Figure 4. Processing & the printing of the Personal Dose
evaluation of the OSLs Monitoring Report.

4.6. RPS provides the dose evaluation report to the client

After the evaluation is completed and reviewed, a Personal Dose
Monitoring Report is generated. A copy of this Report is given to
the client through their Radiation Safety Officer for records keeping
and assessment of the safety in the
radiation facility. “Dose Evaluation
Reports are
Dose Reports will be available to the clients
available in 2
after 10 working days (or 2 weeks) following weeks!”
receipt of the used badges by the RPS. An
electronic copy may be sent to the client
upon request. High doses are notified to the
client immediately.

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One report is generated for each monitoring period and include the
following information:
• The monitoring period
• the equivalent doses received by each personnel for that
MP,
• Evaluation Remarks
A sample dose report and the description of its contents is shown
in Appendix D.
After the effective doses have been evaluated, the results are
compared to the regulatory safety limits. Each report contains
several evaluation remarks as a means to guide Radiation Safety
Officers (RSO) on the meaning of the results. It is important that
the RSO takes note of these remarks and make necessary action.
Below are the types of evaluation remarks used and its
description. Radiation safety offices (RSO) should take note of
these remarks.
a. Below MDL – means that the evaluated radiation dose is
below the minimum detection limit (MDL) of the
dosimeter. Any evaluated dose below this level is not
recordable and not considered as occupational exposure.
The MDL depends on the dosimeter used and for the
OSL system used by the RPS, the MDL = 0.06 mSv.

b. Below or Above IL – means that

the evaluated dose is below or “RSOs should
above the Investigation Level (IL). take note of the
remarks & take
Investigation levels are radiation the necessary
dose levels that are equivalent to actions”
one third (1/3) of the prescribed
dose limit. As per regulations, the annual dose limit for
workers is 20 mSv. Hence, the monthly limit is 1.67 mSv
and the equivalent IL is 0.5 mSv.

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 Evaluated dose levels Below IL are still within the
prescribed safety limits. No immediate radiation controls
& actions from the RSO are necessary.

If the evaluated dose level is Above IL, the RSO should

initiate the review the facility’s radiation safety program
and investigate why the personnel was exposed to such
level. Additional radiation controls & safety measures may
be introduced as necessary and as reasonable
achievable to minimize the received doses. This is to
ensure that the dose received by the personnel will not
reach the annual dose limit.

c. Above AL – means that the evaluated dose has reached

the Action Level (AL) and exceeded the dose limit for that
monitoring period. Continued exposure to such levels
may lead to overexposures of personnel.

For this situation, the RSO should take the necessary

actions and radiation controls to avert the dose received
by the personnel.

d. Not Returned – means that the particular dosimeter was

not received by the RPS for evaluation

e. Late Return – means that the particular dosimeter was

received for evaluation more than one month after the
indicated monitoring period

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5. Using your OSL dosimeters

5.1. OSL dosimeter main components

The OSL dosimeter used for the service is a Landauer Inlight XA
dosimeter system. The main components are shown in Figure 5.

Front Back
3

Figure 5. OSL Dosimeter main components

The dosimeter is composed of several components namely:

1. OSL detector slide – contains the four aluminum oxide
(Al2O3) crystals which serves as detector elements
2. Detector case with filters – case where the detector slide is
inserted. It contains the four types of filtration system: a)
open window, b) plastic filter, c) aluminum filter and d)
copper filter. The case also contains the serial number of the
dosimeter.
3. Clip lock – the component that locks the badge, badge
holder and badge clip and other dosimeter components
together
4. Plastic badge holder – holds the badge
5. Badge clip
6. Badge – the component used to hold the detector case
(containing the detector slide) in place before it is inserted
into the plastic badge holder.

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5.2. Your dosimeter package
The contents of the dosimeter package received by the client
include the following:
1. OSL dosimeters to be used by
the personnell
2. At least one CONTROL OSL
dosimeter
3. Personal ID Sheet
The Personal ID sheet is a document that contains the following
information:
a) The list of OSL dosimeters inside the package identified in
terms serial number and to whom the dosimeter is assigned
to.
b) The
he serial number of the Control dosimeter
c) Client information (name, address, client code)
d) Classification of p
practice such as industrial radiography,
conventional radiology, nuclear medicine, radiotherapy, etc..
e) Monitoring Period or the duration of use

A sample
ample Personal ID sheet and the description of its contents
co is
detailed in Appendix C.

“An OSL issued to Note that the OSL dosimeters are NOT
one person must interchangeable and should be used only
never be used by by the personnel to which it was assigned
another person!!”
to. The RSO or authorized contact persion
should notify the RPS of any changes in
personnel details.

5.3. Using your dosimeters

After the OSL dosimeters have been received and assigned to the
respective personnel, the RSO should ensure that the personnel
wears them properlyy while working with ionizing radiation.

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Everytime a worker enters a radiation (or
suspected) area, he/she should wear the
OSL dosimeter to monitoring occupational
doses received.

1. Pin or clip OSL dosimeter to your

body with the front part of the badge
facing away from the body.

2. Wear the OSL dosimeters around

the chest area to best measure the
doses received by the upper torso. If
however, one part of the body is most likely to be exposed
than the other parts, such as the waist, neck, or back, place
the dosimeter on that area. Do not allow clothing, buttons,
pens or buckles to shield the front of the badge.

3. If protective clothing is used, wear the dosimeter using the

following guidelines

a. When dealing primarily with penetrating radiation such

as X-rays or gamma-rays, place the OSL dosimeter
under the protective clothing

b. When a non-penetrating radiation type is expected

(e.g. beta radiation, or photon radiation < 20 keV
average) and the eyes or substantial areas of skin are
unprotected (e.g., the face and neck), then the
dosimeter should be placed on the outside of the
protective clothing to ensure proper measurement of
shallow dose.

However for areas with potential contamination, place

the dosimeter in a thin plastic bag before wearing to
avoid cross contamination.

c. When a lead vest / apron is used, place the dosimeter

underneath it in order to measure efficiency of the vest
/ apron in protecting the personnel.

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 4. At the end of each work in the radiation facility, remove the
OSL dosimeter and store it together with the Control
dosimeter.

The Control dosimeter

A CONTROL dosimeter is always sent with each dosimeter
package in order to monitor a) the radiation received during transit
and b) the background radiation during storage. It must not be
used by any personnel or for any other purpose.

Control dosimeters should be placed in

normal background radiation area and away
“Place the Control
dosimeters as far from radiation facility as much as possible. It
AWAY from the should never be placed near or on top of the
radiation source radiation source.
as possible”
Control dosimeters are typically stored
together with the other dosimeters when not
used or worn. It must be returned together with the used badges
after each MP. The dose received by the Control will be
substracted from dose received by each personnel during the
dose evaluation discussed in Section 4.5.

5.4. Storing & caring for your dosimeters

1. The OSL dosimeters provided to the client are locked inside
the plastic badge holder. It must not be opened or removed
from the holder in any way as it may damage the dosimeters
or affect the accuracy of the dose evaluation.
2. When not in use, store the OSL
dosimeters together with the Control
badge in a radiation free area, “Ensure proper
preferably in a designated location storage & care
for your OSL
such as the office, or locker area. This dosimeters!”
location should be out of direct
sunlight and away from excessive heat
or radioactive sources.

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 3. Avoid taking the dosimeters at home or during a medical
procedure.
4. The dosimeters are not water tight. Take necessary
precautions to prevent it from getting wet.

5. Always take the necessary precaution to prevent

contamination of the dosimeters as it may significantly affect
the dose evaluation.

6. NEVER deliberately expose the OSL dosimeters.

5.5. Records keeping

A Personal Dose Evaluation Report is provided to each client for

each MP after the used dosimeters are returned. A copy of this
Report is given to the client through their Radiation Safety Officer.

“Records keeping is very essential in

a) Providing analysis for dose distributions

b) Evaluating exposure trends
c) Optimizing effective of monitoring procedures and programs
and
d) Provide data for epidimiological studies

“The management through the RSO shall therefore maintain

exposure records for each worker by keeping the dose evaluation
reports.
Dose records should be kept up date and procedures should be
established to ensure that assessments of dose from any
monitoring period reach the individual’s dose record promptly.
The management through the RSO shall

• provide workers with access to information on their own

exposure records
• provide the regulatory authority, health surveillance agency
and the relevant employer access to the exposure records

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 • facilitate provision of copies of worlers exposure records to
new employers when workers change employment

• give due care and attention to the maintenance of

appropriate confidentiality of records
Exposure records records for each worker shall be preserved
during the worker’s working life and afterwards at least until the
worker attains the age of 75 years and/or for not less than 30
years after the termination of the works involving occupational
exposure.”

6. References
[1] Hanford External Dosimetry Technical Basis Manual, PNNL-
15750 Rev. 1.1, PNL-MA-842, Washington, May 2010
[2] Code of PNRI (CPR) Regulations Part 3, Standards for
Protection Against Radiation, PNRI, 2006
[3] FOOD AND AGRICULTURE ORGANIZATION OF THE
UNITED NATIONS, INTERNATIONAL ATOMIC ENERGY
AGENCY, INTERNATIONAL LABOUR ORGANISATION,
OECD NUCLEAR ENERGY AGENCY, PAN AMERICAN
HEALTH ORGANIZATION, WORLD HEALTH
ORGANIZATION, International Basic Safety Standards for
Protection against Ionizing Radiation and for the Safety of
Radiation Sources, Safety Series No. 115, IAEA, Vienna
(1996).
[4] Landauer Inc., Inlight Systems Microstar User Manual,
Version 4.3, 2012
[5] INTERNATIONAL ATOMIC ENERGY AGENCY,
INTERNATIONAL LABOUR OFFICE Assessment of
Occupational Exposure Due to External Sources of Radiation,
Safety Guide No. RS-G-1.3, IAEA, Vienna, 1999
[6] INTERNATIONAL ATOMIC ENERGY AGENCY,
INTERNATIONAL LABOUR OFFICE, Occupational Radiation
Protection, Safety Standards Series No. RS-G-1.1,IAEA,
Vienna (1999)

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 Appendix A: Application Form

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WI-5.4.1 Rev.1 (2013) 21
 Appendix B: Memorandum of Agreement
MEMORANDUM OF AGREEMENT

This AGREEMENT, made and entered into this ________ day in the month of _________ of
the year 20__ in Quezon City, Metro Manila, between:
The PHILIPPINE NUCLEAR RESEARCH INSTITUTE, Department of Science and
Technology under Republic Act 2067 as amended and organized under Executive Order 128
on January 30, 1987, represented by its Director, and referred to as the PNRI,
-and-
______________________________________, with address at _______________________
a government/private entity operating and doing business under Philippine law, and referred
to as the CLIENT.
WITNESSETH
The PNRI is the owner of the OSL Dosimeters, each unit consisting of an OSL card and card
holder, which are available for use in order to monitor the workers occupationally exposed to
radiation for radiation protection purposes, the issuance of such units forming part of the
personnel monitoring service rendered by PNRI
The CLIENT desires to avail of the personnel monitoring service and hence the use of the
PNRI’s OSL Dosimeter unit described above in connection with the client’s use and/or
handling of radioactive materials and/or radiation sources.
THE PNRI and the CLIENT agree to the following:
The PNRI shall allow the use of the OSL Dosimeter to the CLIENT, and the client
shall accept and take possession of the said Dosimeter subject to the following terms
and conditions:

a. The client shall use the OSL Dosimeter unit exclusively for the purpose indicated
above within the monitoring period:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

b. The CLIENT shall pay the PNRI for the personnel monitoring service including the
use of the Dosimeter for P 160.00/unit/monitoring period which shall be for one or
two months according to the prescribed usage period AND an advance payment
equivalent to three monitoring periods. The CLIENT shall provide and be
responsible for the delivery or collection of the Dosimeters, or a delivery fee shall be
charged to them.

c. The CLIENT shall return for evaluation the dosimeter units to PNRI at the end of the
stipulated monitoring period provided above without need of notice from the PNRI.
Failure to return the unit one month after the prescribed period of use, shall make the
client liable to pay PNRI the amount Php 250.00 for the late return of the Dosimeter.

d. The CLIENT shall be responsible for the loss or damage of the OSL Dosimeter while
it is under its custody and shall REPLACE the lost or damaged Dosimeter with
another Dosimeter of the same quality & specifications.

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 This agreement is effective for TWO YEARS and shall supersede and revoke
any prior contract concerning the OSL Personnel Monitoring Services which
PNRI has executed with the CLIENT, and may be amended, modified, or earlier
terminated at the option of the PNRI.

Signed and sealed this ______ day of ___________________, 20___.

PHILIPPINE NUCLEAR RESEARCH INSTITUTE CLIENT

by by

ALUMANDA M. DELA ROSA, Ph. D __________________________

Director Signature over printed name

WITNESS
ESTRELLA S. CASERIA ___________________________
Signature over printed name Signature over printed name

ACKNOWLEDGEMENT

Republic of the Philippines

Quezon City

BEFORE ME, Notary Public of

_________________________________________________________
Personally appeared DR. ALUMANDA M. DELA ROSA with Passport No. OE0006886 issued at
DFA MANILA on MAY 24, 2012 .
and
______________________________________ with Residence Certificate No.
__________________________
issued at ___________ on ___________________, 201_ known to me to be the same persons who
have executed the above Contract of lease and who acknowledged that the same is their voluntary act
and deed. I further certify that this document consists of (2) pages, including this page upon which this
acknowledgement is written, and that the parties together with their instrumental witnesses have signed
their names on the left-hand margin of each page of this document.

WITNESS my hand and seal this _____ day of __________ 201__ at

the________________________, Philippines.

NOTARY PUBLIC
Until December 31, 201_
PTR No. ____________

Doc. No. ___________

Page No.___________
Book No.___________
Series of 200________

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 Appendix C: Personal Identification Sheet

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 Appendix D: Personal Dose Monitoring Report

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