In the realm of occupational health and safety within educational and research institutions, the North Carolina RS 11 form plays a crucial role, particularly at North Carolina State University (NCSU). This document outlines the procedure for voluntarily declaring pregnancy to NCSU's Radiation Safety Division, adhering to the state's protective regulations against radiation exposure. It not only serves as a declaration but also as a comprehensive guide for expectant employees on how to manage radiation exposure during pregnancy. The form is divided into critical sections, starting with the voluntary pregnancy statement, followed by instruction to the employee, which encompasses both oral and written information about the risks associated with prenatal radiation exposure and methods to minimize these risks. It reviews the employee's previous personnel monitoring results, if available, and outlines the fetal dose limit during gestation as prescribed by state regulations and the U.S. Nuclear Regulatory Commission. The dosimetry evaluation section discusses the use of additional fetal dosimetry devices for those with potential exposures exceeding 10% of the established limits, ensuring ongoing assessment and safety of the fetus through the pregnancy. Lastly, acknowledgments by the declarer and the Radiation Safety Officer affirm the information exchange and understanding of the risks involved. This form embodies NCSU's commitment to safety and regulatory compliance while supporting the well-being of its pregnant employees and their unborn children.
| Question | Answer |
|---|---|
| Form Name | North Carolina Form Rs 11 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | rs11 filling online pregnancy forms |