Ref. No.		
General details	
	
Which MBA? 	 AS-		Start date:		Finish date:			
	
Conducted by:		Names of assisting persons:	

Conducting the PIT    refer to the Explanatory Notes on the reverse of this form
	
Methods used:	

		
	
Any issues arising?	

		
	
Tick if there is a MUF?		Material category:		Weight of MUF:		Kg 	
grams		
	
If a MUF, provide full details:	

		
	
Signature
	
Name :			
	
Position:			
	Signature:	_____________________________________	Date:	____/____/________	
	
Permit Holder:		Permit No.			

Explanatory Notes

Ref No		A sequential reference number is required for each form of this type submitted by the Permit Holder (eg 001, 002, 003 etc). Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg 2005-003 Rev 1)	
Finish date		This report is to be submitted to ASNO no later than 30 calendar days after this date.	
Names of assisting persons		
List all persons directly involved in the PIT.	
Methods used		Indicate whether the PIT was concluded using item counting, random sampling, or non-destructive analysis (NDA).	
Any issues arising 		Describe any problems encountered during the PIT and possible countermeasures that could stop their recurrence in future PITS, or could improve the efficiency and/or effectiveness.	
Material category		Options are D (depleted uranium), N (natural uranium), L (uranium enriched to <20%), H (uranium enriched >20%), P (plutonium), T (thorium), W (heavy water), or G (graphite).	
If a MUF		Provide full details of the circumstances in which the MUF was created (to the extent known), including details of the element and isotope weights (if applicable), batch / item numbers, etc. 
Include details of proposed measures to prevent a recurrence.	
Signature		This form must be signed by a representative of the Permit Holder (i.e. the organisation) who will take responsibility and sign documents on behalf of the organisation.	

This form replaces the following forms 	ASO320 (version 2 issued 22July 2010) and ASO321