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L-0.2, r. 1 - Regulation respecting the application of the Act respecting medical laboratories and organ and tissue conservation
Schedule
Disposition versions
SCHEDULE 10
(s. 189)
FORM TO BE SIGNED BY THE FEMALE STAFF OF A GENERAL MEDICAL IMAGING OR SPECIFIC DIAGNOSTIC RADIOLOGY LABORATORY, SECTION 189
I acknowledge having taken cognizance of the limits of exposure to x-rays as provided for in Table 3 of Schedule 8 reproduced below.
Organ or tissue Maximum
permissible dose (MPD)
equivalents in rems
Quarterly Yearly
Whole body, gonads, red bone marrow, lens of eye 1.3* 5*
Bone, skin, thyroid 15 30
All tissue of the hands, forearms, ankles and feet 38 75
Other single organs or tissues 8 15
These MPD exclude doses received for medical and para-medical purposes and natural background radiation.
*The dose to the abdomen must not exceed 0.2 rem over a 2-week period and, if the woman is pregnant, such dose must not exceed 1.5 rem per year.
I undertake to advise the permit holder of any pregnancy.
name of employee
signature of employee
date
name of permit holder
signature of permit holder
date
This form must be filed with the employee’s record.
SCHEDULE 10
(s. 189)
FORM TO BE SIGNED BY THE FEMALE STAFF OF A DIAGNOSTIC RADIOLOGY LABORATORY, SECTION 189
I acknowledge having taken cognizance of the limits of exposure to x-rays as provided for in Table 3 of Schedule 8 reproduced below.
Organ or tissue Maximum
permissible dose (MPD)
equivalents in rems
Quarterly Yearly
Whole body, gonads, red bone marrow, lens of eye 1.3* 5*
Bone, skin, thyroid 15 30
All tissue of the hands, forearms, ankles and feet 38 75
Other single organs or tissues 8 15
These MPD exclude doses received for medical and para-medical purposes and natural background radiation.
*The dose to the abdomen must not exceed 0.2 rem over a 2-week period and, if the woman is pregnant, such dose must not exceed 1.5 rem per year.
I undertake to advise the permit holder of any pregnancy.
name of employee
signature of employee
date
name of permit holder
signature of permit holder
date
This form must be filed with the employee’s record.
