Embed Size (px)
Citation preview
Radiation Worker Registration, URCC-6 v4
Date of first issue: March 2014 Document is uncontrolled when printed
For the latest version of this document please go to: http://www.mun.ca/health_safety/OHSMS/RSMS/
Page 1 of 3
Radioisotope Worker Registration Form
Worker Name Male
Female (Given Name)
Position If other, describe
Office # Office telephone #
Radioisotope User Permit (RUP) holder name:
Faculty/department/
Please complete all applicable sections of this form if you will be working in a laboratory where open or sealed source nuclear substances are in use. Fields highlighted red are mandatory.
My.mun.ca login name
(Surname)
Radiation dosimetry registration
Date of birth Social Insurance Number (SIN)
Place of birth (Province of Canada or country if outside Canada)
Have you worn a radiation dosimeter badge before?
If yes, when and where?
Radioisotope(s) handled:
Complete this section ONLY if you are registering for radiation dosimetry (see appendix for requirements).
Radiation safety training course (D2L) completion date
Radiation safety training course (D2L) completed
Radiation Worker Registration, URCC-6 v4
Date of first issue: March 2014 Document is uncontrolled when printed
For the latest version of this document please go to: http://www.mun.ca/health_safety/OHSMS/RSMS/
Page 2 of 3
RUP holder Date
RUP holder Authorization
DateRadiation worker
I agree to learn and comply with prescribed procedures and safety regulations when working with radioactive materials and will perform my work in a manner which will minimize radiation risks to me, my fellow workers, and the public. I will take reasonable care to ensure that radiation dosimeter badges issued to me do not become lost, damaged or destroyed. I have read and understand the policies and procedures outlined in the Memorial University of Newfoundland Radiation Safety Manual and accompanying Radiation Safety Operating Procedures (RSOP's) and agree to abide by these policies and procedures at all times. I understand that I may be personally liable for administrative monetary penalties (AMP's) issued by the CNSC due to regulatory non-compliance.
I wish to add the radioisotope worker described in this form to my radioisotope user permit. I have ensured that said worker has read and understood the Memorial University of Newfoundland Radiation Safety Manual and accompanying RSOP's and that he/she has been trained in pertinent laboratory safety protocols and procedures. I have also ensured that said worker is aware of the liabilities associated with administrative monetary penalties (AMP's).
Radiation Worker Declaration
Email to: Radiation Safety Officer, [email protected]
For Radiation Safety Officer Use Only
Radiation safety training course completed
Radiation Safety Officer approval Date
PRIVACY NOTICE This information is collected and maintained by the Office of the Chief Risk Officer, Memorial University of Newfoundland (the department) to administer its radiation safety program in accordance with the Nuclear Safety and Control Act, 1997, c 9 (the Act), and for no other purpose. It will be held securely and will not be disclosed except to Health Canada, a dosimetry service provider under the Act. If you have any question about the collection or use of this information, please contact the Radiation & Biological Safety Control Officer at 709-864-8250.
Date
Radiation Worker Registration, URCC-6 v4
Date of first issue: March 2014 Document is uncontrolled when printed
For the latest version of this document please go to: http://www.mun.ca/health_safety/OHSMS/RSMS/
Page 3 of 3
Appendix: Notes about radiation dosimeter badges 1. Personal dosimeter badges measure radiation from x-rays, gamma rays and high-energy beta rays, but are not effective in measuring radiation from low-energy beta emitters such as 3H and 14C (please refer to Radiation Safety Operating Procedure RSOP01A Dosimetry Use External). a. If you work in a lab designated as "Basic" and use 3H, 14C, S35, Ca45 or P33, TLD badges are NOT required. b. If you work with 32P or 51Cr, dosimeters ARE required. c. If you work with sealed sources over 370 kBq that are not contained in a device, dosimeters ARE required d. If you work in a lab designated "Intermediate" dosimeters ARE required. 2. Persons using more than 50 MBq (1 mCi) of 32P are required to wear extremity (ring) dosimeters in addition to the regular whole-body dosimeter badges. Other situations requiring extremity dosimeters will be decided on a case-by-case basis 3. The radiation dosimeter badges used at Memorial University are the property of the National Dosimetry Services, Health Canada. 4. In addition to charges for the basic dosimetry service, extra charges are levied by Health Canada for late and missing dosimeter. 5. Badges are exchanged four times a year - February, May, August, and November. 6. A badge can be returned prior to the scheduled change date in cases where excessive radiation exposures are expected and an early report is desired. 7. When a badge wearer is leaving Memorial or no longer needs to wear a badge, the badge must be returned to the Radiation Safety Officer. 8. Care must be taken to prevent loss of badges. When a badge becomes lost, it is impossible to measure a person's radiation exposure for the period, and a lost badge fee is charged to the permit holder. 9. Radiation dosimeters are intended to measure a person's occupational radiation exposure and should be worn at all times when working in radioisotope laboratories or in the vicinity of x-ray equipment. Care should be taken not to store badges in locations where they might be exposed to radiation while they are not being worn. Badges must not be worn when receiving radiation for medical purposes. 10. For additional information, contact the Radiation Safety Officer, telephone 864-8250, email [email protected].
