On March 11, 2020, the NRC issued a Notice of Violation to Avera St. Luke’s Hospital (Licensee) for a Severity Level III problem associated with three related violations. The violations involved the licensee’s failure to: (a) monitor occupational exposure of workers from licensed and unlicensed sources of radiation as required by Title 10 of the Code of Federal Regulations (10 CFR) 20.1502(a)(1); (b) develop and implement certain elements of its radiation protection program in accordance with 10 CFR 20.1101(a); and (c) submit a written report to the NRC within 30 days of discovery of a reportable event in accordance with 10 CFR 20.2203. Specifically, from February 2018 through July 30, 2019, the licensee did not properly monitor an authorized user’s radiation exposure that resulted in the authorized user having a significant potential to exceed the NRC’s annual radiation exposure limit and did not develop and implement a radiation protection program commensurate with the scope and extent of its licensed activities. Additionally, on October 3, 2018, the licensee was notified by a dosimetry vendor of an exposure potentially exceeding the NRC’s annual exposure limits for an authorized user working under its NRC license, and the licensee did not investigate or notify the NRC until July 30, 2019.