RADIATION PROTECTION BOARD OHSA Building 17 Edgar Ferro Street, Pietá, PTA1533 Malta Tel: , Fax:

Transcription

1 RADIATION PROTECTION BOARD OHSA Building 17 Edgar Ferro Street, Pietá, PTA1533 Malta Tel: , Fax: APPLICATION FOR AUTHORISATION TO TRANSPORT RADIOACTIVE SUBSTANCES Form is to be filled in and returned to the Radiation Protection Board RPB-TR-01 1 of 5

2 Under the Nuclear Safety and Radiation Protection Regulations 2003, any practice which involves a risk from ionizing radiation emanating from an artificial source or from a natural radiation source in cases where natural radionuclides are being or have been processed in view of their radioactive, fissile or fertile properties including The production, processing, handling, holding, storage, transport, supply, import to and export from Malta, transit through Maltese territory, design, manufacture, construct or assemble, acquire, distribute, sell, loan or hire, possess, locate, commission, use and operate, maintain or repair, transfer or decommission, disassemble, and disposal of radioactive substances, is required to be authorised by the Radiation Protection Board. This application is designed solely for the transport of radioactive material from one location to another location. Importation procedures (including purchase or leasing of a source) fall outside the remit of this type of Authorisation. Malta Transport is the Competent Authority for issuing Dangerous Goods Safety Advisor certification and Class t driver licenses. GENERAL TYPE OF NOTIFICATION New notification Amendment to existing authorisation number PURPOSE OF NOTIFICATION Setting up new Transport Organisation Altering facility Commencement of radioactive material transport operation RPB-TR-01 2 of 5

3 I. GENERAL INFORMATION ORGANISATION DETAILS I-1. Name of Radiation Employer: Organisation Address Telephone No.. Fax No. address: I-2. Work locations (Applicable only to entities that work with radioactive material): Will the work be carried out at any address other than given in item I-1 (tick correct answer) Yes No List all other known addresses were work is undertaken with sources (if applicable): Note: The Radiation Protection Board will require notification prior to work at any other site not specified in I-1 or I-2 above. I-3. The Legally Responsible Person: Position: I.D. No I-4. The Dangerous Goods Safety Advisor: Cert. No. RPB-TR-01 3 of 5

4 I-5. I-6. Indicate briefly the nature and business of the radiation employer named in I-1 above: I-7. Proposed date of commencement of the work activity: Date RPB-TR-01 4 of 5

5 II. SIGNATURE AND CERTIFICATION II.1 Declaration The radiological risks associated with the transport of radioactive material, have been analysed and all our staff that can come in contact with such material are aware of such risks and always carry with them an emergency card that has been issued to them following such analysis Signature of the legally responsible person ID Card No.: Title: Date: Notes: 1 This form will not be processed unless copies of the DGSA certificate and driver s Class 7 licenses are attached 2. Based on the processing of this form, the Radiation Protection Board may require additional information to fully consider this application prior to issuing an authorization. 3 The Radiation Protection Board will process your data in accordance with the principles of the Data Protection Act. We will not release any information held about you to third parties except where necessary for the fulfillment of this application. We may process your address, telephone, fax or details to contact you in connection with this application. Completion and submission of this application form signifies your consent to the processing of this data. Please contact us if you would like us to inform you about the personal data we hold about you or if you require such data to be corrected. RPB-TR-01 5 of 5