Help on accessing alternative formats, such as Portable Document Format (PDF), Microsoft Word and PowerPoint (PPT) files, can be obtained in the alternate format help section.
This HTML document is not a form. Its purpose is to display the information as found on the form for viewing purposes only. If you wish to submit a form, you must use only the PDF version.
Organization:___________________________________________
Address:_______________________________________________
Telephone:(___)_______ fax:______ e-mail:_____
Contact Person:__________________________________________
Date of Sample Receipt: ___________________________________
Method of Storage: _______________________________________
Is participation in this intercomparison a licence requirement for your organization?
Did the same analyst perform all of the analyses?
If "No", please indicate which analyses were performed by each analyst using the analyst's initials in the column labelled Analyst.
Have the results been corrected for background?
Have the results for t he spike concentration already been decay-corrected to the date of spiking?
Analytical Procedure:
What is the Minimum Detectable Activity (MDA) for your method?_______
State how this way determined
Comments:
Please submit results to the Bioassay Section no later than one month after the measurements took place.
Results can be sent by:
Fax: (613) 957-1089
E-mail: Maria_Zamora@hc-sc.gc.ca
| Date Analysed (m/d/yy) |
Day | Sample Code |
Total Counts |
Count Time (min) |
Counting Efficiency |
Concentration (Bq/L) |
Analyst |
|---|---|---|---|---|---|---|---|
| 1 | sample background |
||||||
| 1 | A | ||||||
| 1 | B | ||||||
| 1 | C | ||||||
| 1 | D | ||||||
| 2 | sample background |
||||||
| 2 | E | ||||||
| 2 | F | ||||||
| 2 | G | ||||||
| 2 | H | ||||||
| 3 | sample background |
||||||
| 3 | I | ||||||
| 3 | J | ||||||
| 3 | K | ||||||
| 3 | L | ||||||
| 4 | sample background |
||||||
| 4 | M | ||||||
| 4 | N | ||||||
| 4 | O | ||||||
| 4 | P | ||||||
| 5 | sample background |
||||||
| 5 | Q | ||||||
| 5 | R | ||||||
| 5 | S | ||||||
| 5 | T |
Supervisor:________________