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									Date: _____________ Day: ___________ Time: _____________       Date: _____________ Day:____________ Time: _____________

EOIC/Shift Leader: ____________ Operator: ________________     EOIC/Shift Leader: ____________ Operator: ________________
Operating running condition: □ Unattended without beam         Operating running condition: □ Unattended without beam
                             □ With beam                                                    □ With beam
                             □ No beam, no rf                                               □ No beam, no rf
  Always:           rf conditions         beam conditions        Always:           rf conditions         beam conditions
□ weekly check    □ BAS signed          □ BAS signed           □ weekly check    □ BAS signed          □ BAS signed
                  □ RE Interlock test   □ BCS checks (1/day)                     □ RE Interlock test   □ BCS checks (1/day)
Program:                                                       Program:




Date: _____________ Day: ___________ Time: _____________       Date: _____________ Day:____________ Time: _____________

EOIC/Shift Leader: ____________ Operator: ________________     EOIC/Shift Leader: ____________ Operator: ________________
Operating running condition: □ Unattended without beam         Operating running condition: □ Unattended without beam
                             □ With beam                                                    □ With beam
                             □ No beam, no rf                                               □ No beam, no rf
  Always:           rf conditions         beam conditions        Always:           rf conditions         beam conditions
□ weekly check    □ BAS signed          □ BAS signed           □ weekly check    □ BAS signed          □ BAS signed
                  □ RE Interlock test   □ BCS checks (1/day)                     □ RE Interlock test   □ BCS checks (1/day)
Program:                                                       Program:




Date: _____________ Day: ___________ Time: _____________       Date: _____________ Day:____________ Time: _____________

EOIC/Shift Leader: ____________ Operator: ________________     EOIC/Shift Leader: ____________ Operator: ________________
Operating running condition: □ Unattended without beam         Operating running condition: □ Unattended without beam
                             □ With beam                                                    □ With beam
                             □ No beam, no rf                                               □ No beam, no rf
  Always:           rf conditions         beam conditions        Always:           rf conditions         beam conditions
□ weekly check    □ BAS signed          □ BAS signed           □ weekly check    □ BAS signed          □ BAS signed
                  □ RE Interlock test   □ BCS checks (1/day)                     □ RE Interlock test   □ BCS checks (1/day)
Program:                                                       Program:




Date: _____________ Day: ___________ Time: _____________       Date: _____________ Day:____________ Time: _____________

EOIC/Shift Leader: ____________ Operator: ________________     EOIC/Shift Leader: ____________ Operator: ________________
Operating running condition: □ Unattended without beam         Operating running condition: □ Unattended without beam
                             □ With beam                                                    □ With beam
                             □ No beam, no rf                                               □ No beam, no rf
  Always:           rf conditions         beam conditions        Always:           rf conditions         beam conditions
□ weekly check    □ BAS signed          □ BAS signed           □ weekly check    □ BAS signed          □ BAS signed
                  □ RE Interlock test   □ BCS checks (1/day)                     □ RE Interlock test   □ BCS checks (1/day)
Program:                                                       Program:

								
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