DD Form 1952 at a glance
What it is: DD Form 1952 is the Dosimetry Application and Record of Previous Radiation Exposure, prescribed by AR 385-10 and DA Pam 385-24.
Who signs: You sign at a. SIGNATURE and enter the date at b. DATE SIGNED (YYYYMMDD).
If information is not furnished, individual may not become a radiation worker.
A filled-in DD Form 1952 example: a new radiation worker with no earlier employer
How to fill out DD Form 1952, box by box
Personal information
Print legibly or type all information requested.
Enter the Full Name (Last, First, Middle Initial) in box 1 and the Date of Birth (YYYYMMDD) in box 2.
Enter the Social Security No. in box 3a, the DODID No. in box 3b and the Duty Section (Dept., Unit, etc. or Company, if contractor) in box 4.
Enter the Job Title in box 5.
Enter the Duty Phone in box 6 and the Email Address in box 7.
In box 8, YES or NO: have you worn a dosimeter issued by this command in the past? In box 9, mark one Duty Status (X One): Permanent or Temporary (6 weeks or less).
Occupational exposure history
OCCUPATIONAL EXPOSURE HISTORY: This section only applies to the individual who has worked with radiation producing devices or radioisotopes. List only those employers for whom you worked with radiation. If you have not been issued a dosimeter previously, enter “NONE” in the first block.
Enter the Name of Employer in box 11.
Enter the Address (street address, city, state, zip code) in box 12.
Enter FROM MO. and YR. in box 13 and TO MO. and YR. in box 14. RSO Use Only (Date History Requested) in the same row is for the RSO.
Enter the Total Exposure in box 15. Attach a list if needed.
In box 17, initial (a) or (b): (a) I state that I have had no prior occupational dose during the calendar year, or (b) I state that I have received an estimated total dose of ____ during the current calendar year.
Signing the certification
Box 18 certifies that the exposure history listed above is correct and complete to the best of your knowledge and belief. In the event of theft or loss, notify the RSO or his/her delegate immediately. Under the provisions of 10 CFR 19.13, 29 CFR 1910.1096 and the Privacy Act of 1974, you authorize the release of all radiation exposure records. Radiation protection instruction is provided by 10 CFR 19.12 and 29 CFR 1910.1096. Pregnant female workers may formally declare their pregnancy to be restricted to a lower dose limit, and female workers should contact the RSO for additional training when they disclose their pregnancy.
You sign at a. SIGNATURE and enter the date at b. DATE SIGNED (YYYYMMDD).
Required Monitoring
Box 19, Radiation Monitoring? YES or NO. If no, leave boxes 20 through 25 blank.
Required Monitoring is for RSO use only.
Box 20, Dosimeter? YES or NO, with NEUTRON, HEAD & NECK, FINGER and WHOLE BODY.
Box 21 is the Frequency: MONTHLY, QUARTERLY, SEMI-ANNUALLY, ANNUALLY or OTHER.
Box 22, Bioassay? YES or NO. Box 23, Baseline? YES or NO.
Box 24 is the Specimen Type(s) and Radionuclides. Box 25 is the Frequency: MONTHLY, QUARTERLY, SEMI-ANNUALLY, ANNUALLY or OTHER.
The RSO enters the Signature of RSO, the Date Signed (YYYYMMDD) and any Additional Notes.
More rules for DD Form 1952
Principal purpose: to monitor, evaluate, and control the risks of individual exposure to ionizing radiation or radioactive materials.
The installation or activity must maintain a completed Automated Dosimetry Record (ADR) on each individual occupationally exposed to ionizing radiation or radioactive material.
Box 16: Individual has received instruction on potential hazards associated with use of or exposure to radiation, with a. DATE (YYYYMMDD), b. RSO'S INITIALS and c. INDIVIDUAL'S INITIALS.
Disclosure is voluntary.
Sources
[1] DD Form 1952 (APRIL 2021), Dosimetry Application and Record of Previous Radiation Exposure, U.S. Department of Defense (the Official source link on this page).