Special Medical Examination Questionnaire for Radiation-Related Workers (Questionnaire)
Questionnaire Entry Flowchart (Employee)
STARTNO③

Will you engage in radiation-related work* this year?
*Handling of unsealed RIs, sealed RIs, X-ray generators, nuclear
fuel materials; use of accelerators, sychotron radiation facilities;
entry into the controlled areas

YES

Have you engaged in radiation-related work at Nagoya University?
(Includes RI training, X-ray training, and undergraduate practical training. Does not include lecture-only classes.)

YESNO

What radiation-related work qualifications
do you possess?

Have you engaged in radiation-related
work outside of Nagoya University?

NO

1st Class (RI & X-ray)
3rd Class (X-ray)
2nd Class (RI)YES

Are you registeredas a radiationrelated worker atNagoya University?

Have you everundergone a Special
Medical Examination
for Radiation-RelatedWorkers?

NONO①YESNO②

Are you scheduled
to upgrade from
3rd Class to 1st or
2nd Class?

YES⑤

Are you scheduled tobegin radiationrelated work during
the validity period ofyour medical
examination (within 6months)?

YESUnknown⑥⑦

Please fill out Section B: "New Workers" on the Questionnaire andthe Special Medical Examination on the designated date and① undergotime.
Please fill out Section A: "Continuing Workers" on the Questionnaire andit to the administrative staff of your department by the② submit
designated date.

NO

①YES

④③You do not need to take the Special Medical Examination.
Please ask your department to contact the Personnel Affairs & Labor
Division, General Affairs Department and request that they delete yourRadiation-Related Worker Registration.
Please note that if a worker has not engaged in radiation-related workfor at least 5 years and no request for deletion is made, the Personnel
Affairs & Labor Division, General Affairs Department will delete that
person's radiation-related worker registration.

④Please begin radiation-related work during the validity period of your
medical examination (within 6 months). After beginning radiation-related
work, please fill out Section A: "Continuing Workers" on theQuestionnaire and submit it to the administrative staff of yourdepartment. (Administrative staff: After completing the Supervisor’s
Entry Field, please submit the questionnaire to the Personnel Affairs &Labor Division, General Affairs Department and seek medical advice.)⑤

Please fill out Section C: "I am new to radiation-related work at Nagoya
University, but I have engaged in this work outside of the University" onthe Questionnaire and submit it to the administrative staff of yourdepartment along with your radiation exposure log from your previous
radiation-related work outside of the University. (Administrative staff:
After completing the Supervisor’s Entry Field, please submit thequestionnaire to the Personnel Affairs & Labor Division, General Affairs
Department and seek medical advice.)⑥

Please fill out Section C: "I am scheduled to obtain RI Qualification inaddition" on the Questionnaire and submit it to the administrative staffof your department. (Administrative staff: After completing theSupervisor’s Entry Field, please submit the questionnaire to thePersonnel Affairs & Labor Division, General Affairs Department andseek medical advice.)contact the administrative staff of your department or the⑦ Please
Radiation Safety Control Office, Radioisotope Research Center.