{"id":15951,"date":"2019-03-14T12:01:17","date_gmt":"2019-03-14T16:01:17","guid":{"rendered":"https:\/\/www.bu.edu\/ehs\/?page_id=15951"},"modified":"2019-06-06T11:16:58","modified_gmt":"2019-06-06T15:16:58","slug":"replacement-dosimeter","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/ehs\/radiation-safety\/radiation-safety-operational-forms\/replacement-dosimeter\/","title":{"rendered":"Replacement Dosimeter Request"},"content":{"rendered":"<p><strong>Please note: Use of this online form is the preferred method for submitting a request for a replacement dosimeter badge. Requests submitted via any other method may result in processing delays.<\/strong><\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' 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gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_4' id='input_122_4' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_122_4_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_122_4_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_122_4' class='gform_hidden' value='https:\/\/www.bu.edu\/ehs\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_122_5\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_122_5\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Do you acknowledge that upon receiving your personal dosimeter, per Boston Medical Center \u2013 Personnel Radiation Monitoring and Protection Policy, you may not take the dosimeter off BMC property and when the dosimeter is not in use it must be stored in your department\u2019s approved dosimetry rack or other approved location.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_122_5'><li class='gchoice gchoice_122_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='YES'  id='choice_122_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_122_5_1' id='label_122_5_1' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li 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