ANNEX XIV附則
ANNEX XIV Information to be provided in the records for high-activity sealed sources (HASS) as referred to in Article 89 Text of image STANDARD RECORD SHEET FOR HIGH-ACTIVITY SEALED SOURCES (HASS) (optional in italics) 1. HASS identification number Manufacturer device number Field of use: 2. Identification of the licenced undertaking Name: Address: Country: Manufacturer Suplier User 3. Location of HASS (Use or storage) if not the same as in 2. Name: Address: Country: Fixed use Storage Mobile use 4. Recording Date of start of recording: Date of transfer of records to historic file: 5. Licence Number: Date of issue: Date of expiry: 6. Operational controls of HASS Date: Date: Date: 7. HASS characteristics 8. Receipt of HASS Date of receipt: Date: Year of manufacture: Date: Radionuclide: Date: Activity at the date of manufacturing: Receipt from: Date: Date: Date: Activity reference date: Name: Address: Country: Manufacturer Supplier Another user Date: Manufacturer/Supplier (*): Date: Name: Date: Address: Date: Country: 9. Transfer of HASS 10. Further information Physical and chemical characteristics Date of transfer: Loss Date of loss: Source type identification: Transfer to: Theft Date of theft: Capsule identification: Findings: Yes No ISO classification: Name: Address: Country: Licence number: Date of issue: Date of expiry: Manufacturer Supplier Other undertaking Facility for long term storage or disposal Date: ANSI classification: Place: LAEA source category: Other information: Neutron source: Yes No Neutron source target: Neutron flux: (*) Where the manufacturer of the source is established outside the Community, the name and address of the importer-supplier may be provided instead.