Dose History Summary (DHS) Request Form

The National Dose Registry will release a Personal Dose History Summary (PDHS) upon request. Employers and prospective employers can obtain an Employee's Dose History Summary (EDHS) upon written consent of the radiation worker.

A Dose History Summary (DHS) request form can be printed from this site. Dose records on a DHS are grouped by dose type, year, and employer.

Routine DHS requests are usually processed within 10 working days. Please refer to instructions sheets for more detailed information on how to submit a DHS request to the NDR.

Information for the Employer

1. Please read the Privacy Notice
2. Please review the instruction sheet on how to fill in an Employee's Dose History Summary (EDHS) request form
3. Two options are available on how worker dose records are combined into annual doses.  Please select the proper EDHS request form.
   
   
   1. Employee's Dose History Summary (EDHS)/General request form. Using this form, the year of a dose record is based on the monitoring start date. With this option, a worker's entire dose history is available.
   2. Employee's Dose History Summary (EDHS)/Canadian Nuclear Safety Commission (CNSC) request form.  Using this form, the year of a dose record is calculated according to the regulations of the Canadian Nuclear Safety Commission (CNSC). With this option, the part of a worker's dose history from 2001 is available.

Information for the Worker

1. Please read the Privacy Notice
2. Please review the instruction sheet on how to fill in an Personal Dose History Summary (PDHS) request form
3. Personal Dose History Summary (PDHS) request form

Note: Please print all forms on 8½ x 11 inch paper and adhere to the spaces provided when entering information. Do not add information to the back of the forms after printing.