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Pregnancy verification letter

Proof of pregnancy letter 2026

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This document is a form letter for declaring pregnancy, intended for individuals to notify their employer about their pregnancy in compliance with NRC regulations regarding radiation exposure to an embryo/fetus. It includes sections for personal information and acknowledges the need to limit radiation dose during pregnancy.

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Click ‘Get Form’ to open the proof of pregnancy letter in our editor.
Begin by filling in the recipient's details at the top of the form. Enter 'Vicky Barberini, Dosimetry Coordinator, Box 0942' followed by 'Office of Environmental Health and Safety, UCSF'.
In the section labeled 'I believe I became pregnant in', input the month and year of your pregnancy. This is a crucial detail for compliance with NRC regulations.
Review the statement regarding radiation dose limits to ensure you understand your rights and responsibilities during your pregnancy.
Sign the document in the designated area for your signature, then print your name clearly below it.
Fill in today’s date and provide your phone number for any necessary follow-up communication.

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2005	4.9 Satisfied (272 Votes)

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