STANDARD RECORD SHEET FOR HIGH-ACTIVITY SEALED SOURCES (HASS) (optional in italics)
        1. HASS identification number:                       2. Identification of the authorised holder                               3. Location of HASS (Use or storage) if not the same as in 2.
                                                                  Name:                                                                    Name:
                                                                  Address:                                                                 Address:
                                                                  Country:
                                                             Manufacturer □          Supplier □               User □                  Fixed use: □                           Storage (mobile): □
        4. Registration                                      5. Authorisation                                                         6. Operational control of HASS
        Date of start of registration:                       Number:                                                                  Date:
        Date of transfer of registration to historic file:   Date of issue:                                                           Date:
                                                             Date of expiry:                                                          Date:
        7. HASS characteristic                               8. Receipt of HASS                                                       Date:
                                                                                                                                      Date:
        Radionuclide:                                        Date of receipt:                                                         Date:
        Аctivity at the date of manufacturing or of the                                                                               Date:
        first placing on the market:                         Receipt from:                                                            Date:
                                                                                                                                      Date:
        Date of manufacturing:                                    Name:                                                               Date:
        Manufacturer/Supplier*:                                   Address:                                                            Date:
             Name:                                                Country:                                                            Date:
             Аddress:                                        Manufacturer □          Supplier □               Another user □          Date:
             Country:                                        9. Transfer of HASS                                                      10. Further information
        Physical and chemical characteristics
                                                             Date of transfer                                                         Loss □                                 Date of loss:
        Source type identification:                                                                                                   Theft □                                Date of theft:
        Capsule identification:                              Transfer to:
        ISO classificaton:                                                                                                            Finding:                               Yes □       No □
        ANSI classificaton:                                       Name:                                                                            Date:
        Special form certificate:                                 Address:
                                                                  Country:                                                                         Place:
                                                                                                                                      Other information:
                                                             Manufacturer □          Supplier □               Another user □
                                                             Recognised installation
    * Where the manufacturer of the sources is establishd outside the Community, the name and address of the importer-supplier may be provided instead.