How to write the Application enter "TOKUREI-KUIKI" in NewSUBARUSample

Ver.02

4Radiation Safety Education to enter TOKUREI-KUIKI5
67 Do work under the regulations of JASRI.

!"#)&*#

87 For your safety, follow the warning (notice) board and SPring-8 staff’s
instructions.
97 Contact to guard post (ex.119) immediately when the emergency (injury, fire,and so on) arise.

!"#$%&'%(#:7 Do not smoke, eat, drink, and make up in TOKUREI-KUIKI.
;7 Do not get close to areas and equipments or apparatus irrelevant to your work.

<7 Do not transfer to others, acquisition, rent your “IC tag” of TOKUREI-KUIKI which JASRI lent it to you.
(IC tag: the plastic tag with IC chip)=7 Use your “IC tag” for TOKUREI-KUIKI whenever you enter or leave the TOKUREI-KUIKI.
>7 Contact to JASRI Safety Office promptly if you lose or break “IC tag” for TOKUREI-KUIKI. （Contact; 5532）?7 Return “IC tag” for TOKUREI-KUIKI to JASRI Safety Office after your work is finished.
6@7 There are two signs, Picture A shows
TOKUREI-KUIKI, Picture B at doorway

Ver.02

Submitted date4 2024 (YYYY) / 7 (MM) /to the Safety Office Director,JASRI'29(DD)''Application to enter “TOKUREI-KUIKI” in NewSUBARU'Div./Dept.

JASRI Safety OfficeSection Head*

55' 55

Please conﬁrm worker's signatureon the back of the application form
and then sign by JASRI.

Ankan Taro

Picture Cwhich shows “Radiation
Controlled Area” at the door of Machine
Laboratory. TOKUREI-KUIKI admittanceworker do not enter there.
667 Below the TOKUREI-KUIKI.

Picture (1)' I understand well about every articles of [Radiation Safety Education to enter TOKUREI-KUIKI].

Signature'

DE 2F GHI

Tel!"#$%&' ()*+,-./0123

It should be filled in the JASRI div./dept. of worker.!
*Section Head : administrative post, group leader, and so on!

'' The following person will apply for the approval to enter " TOKUREI-KUIKI " in NewSUBARU.'
When this person enters " TOKUREI-KUIKI ", he/she must work in accordance with Radiation Safety Education on
the back page of this application.

Check the aﬃliation of the worker.
In case the aﬃliation of the worker is not JASRI,
check the "□others" and write down the aﬃliation name.

The worker need to fill in the form within heavy black-edged part and must read to understand the contentson the back of this form, and sign in the column on the bottom.

Affiliation

JASRI

88 Safety Technological Center Institute

6Others7

9

The person who admit the worker to work in NewSUBARU

Affiliated organization
representative

Post

Section chief of technological section(Excluding JASRI staff)

NameAnzen Ichiro

Signature of the person who admit the worker
to work in NewSUBARU（It is necessary only in case worker's aﬃliation is "Others".)

Signature or name & seal

Worker’s namePlanned date of entry

Anzen Jiro(YYYY/MM/DD)

6Experimental HallIDNo.

:;<==88

Contents of work

Fill in SPring-8 IDNo. if the worker have.

2024 / 8 / 5 ~ 2024 / 8 / 23
6Power Supply Room area

Area
Others7'Picture (2)It can be ﬁlled by LASTI,
if the person in charge is involved in LASTI
and the professor of Hyogo University.

Signature or name+seal

The personin chargeof TOKUREI-KUIKI. There is a denotation,

Fill in the period of entry day and check the area.

)'

Check and adjustment of radiation measuring instrument (Ge semiconductor measuring instrument)"concretely#Fill in the contents of work.

Note

Working without check the above "Area" is not permitted.

XYZ[\]^_>?@AAnzen Jiro

Picture (3)