APPLICATION FOR AUTHORISATION - PART 1 Authorisation No.: (Will be assigned by the Norwegian Radiation Protection Authority) General information about the enterprise: Name of enterprise: Registration number:, Registration country: Office:, Postal code:, Place: Postal address:, Postal code:, Place: Tel.:, Fax:, E-mail: Internet address: Application for: New application (first-time application). Change of existing authorisation. Amendment to existing authorisation. Renewal of existing authorisation. State Authorisation No.: State Authorisation No.: State Authorisation No.: According to Regulation of 21 November 2003 on Radiation Protection and Use of Radiation, Sections 5 and 28, the undersigned enterprise herby apply for authorisation in the following categories: Ref. Section 5: a) Industrial radiography and maintenance of industrial radiography equipment b) Industrial irradiators, i.e. the use of ionising radiation to alter material or product quality c) Logging activity, i.e. characterization of structures around bore holes d) Radiation use for research purposes e) Administration of radioactive medicines or substance to persons in connection with medical diagnostics, therapy or research f) Radiation therapy of persons g) Screening activity and use of x-ray diagnostic apparatus by specialist health services, including ordinary x-ray photography and fluoroscopy, angiography and intervention, computer tomography, mammography and dedicated child diagnostics h) Use of accelerators apart from electron microscopes i) Manufacture and import of radioactive medicines j) Addition of radioactive substances in the manufacture of products, and sale of such products k) Manufacture of radioactive sources l) Use of open radioactive sources for tracer surveys outside the laboratory m) Use of sealed radioactive sources with activity levels greater than 10 6 times the exemption levels stated in the annex, apart from in the case of Co-60 where the activity limit is set at 10 GBq n) Use of open radioactive sources with activities requiring a type A isotope laboratory, cf. section 17 o) Discharges of radioactive substances Continue on the next page
Application for authorisation Part 1 Page 2 of 2 p) Facilities for the treatment, storage or final disposal of radioactive waste q) Import and export of radioactive waste r) Distributors of radiation sources s) Magnetic resonance imaging (MRI) for medical purposes Ref. Section 28: Classification of tanning appliances The following requirements are fulfilled, and documentation is attached to the application: The enterprise has an organisation that ensure radiation protecion and radiation safety. The enterprise has sufficient competence in the field of radiation protection. The enterprise has the necessary measuring equipment and other safety equipment. Application form, part 2 for the category in question (a-s) is attached to the application: Yes No Date:, Signature: (for the enterprise) With capital letters:
Application for authorization Part 2 Category A Industrial radiography This form shall be filled in, and the information/documentation requested shall be attached to the application, in addition to the completed Application for authorization Part 1. The references to the various sections below are to Regulations of 21 November 2003 on Radiation Protection and use of Radiation. The application is concerned with: Performing industrial radiography Maintenance of radiography equipment This form can be used in both cases, but not all the content in this form will be relevant if only applied for one of the two options. Additional information about the enterprise: Name and address of department, local office, etc if applicable: The Radiation Protection Officer (RPO) Name of (central) Radiation Protection Officer: Telephone (direct): E-mail: If there is more than one Radiation Protection Officer, give name, organization and area of responsibility on a separate sheet. Please see Attachment No.: To meet the competence requirements outlined in section 8 the Radiation Protection Officer should hold a Norwegian radiation protection certificate. Enterprises performing radiation protection training are; Force Technology Norway AS, Strålevernsspesialisten AS and Institute for Energy Technology (IFE). Does the RPO have a Norwegian radiation protection certificate? Yes No If not, please describe the qualifications: 1
Operators Radiography in shielded enclosures requires one certified operator (with Norwegian radiation protection certificate). Site radiography requires two certified operators. Radiography in shielded enclosures A shielded enclosure is an enclosed space designed and engineered to provide adequate shielding from ionizing radiation to persons in the vicinity. It incorporates engineering controls to prevent unauthorized access to the sources, and to prevent or minimize potential exposure of persons who do enter when the sources are exposed or energized. To avoid the requirement for two certified operators the shielded enclosure must be approved by the NRPA. Site radiography When objects to be radiographed cannot be physically moved into a shielded enclosure it will be necessary to carry out the work under site radiography condition. Name of the operators: Name Date of employment Does the enterprise have a copy of the radiation protection certificate? Statistical information: Number of shielded enclosures in the enterprise Number of exposures per year in site radiography (estimate) Number of exposures per year in shielded enclosures (estimate) Total number of radiographers in the enterprise Number of certified operators. Number of X-ray generators. Number of exposure containers with a gamma source Number of exposures outside the enterprise Irradiators 2
Exposure containers for gamma radiation Model/Type Weight of depleted uranium Serial number Acquired - year Type of source X-ray generators Model/Type Serial number Acquired - year kv-max Accelerators Model/Type Serial number Acquired - year MV-max Safety equipment General Number Gamma rad. Number X-ray rad. Number Measuring Remote Aperture instrument source handling tool Personal acoustic Bags with Cover made warning device Barrier tape Warning light pieces of lead Emergency container of lead Warning light 3
Instruction/Procedure Tick off which instructions and procedures exist relative to the use of radiation sources: Instruction/Procedure Exists Dated Comment For the Radiation Protection Officer For users handling the sources Work activities / execution Maintenance / service of equipment Storage of radioactive sources Transport of radioactive sources Accidents warnings / notifications Accidents - handling Maintenance of exposure containers for gamma radiation Give a short description of the system for maintenance of equipment for gamma radiography. Physical protection of gamma sources Give a description on how the radioactive sources are physical protected against theft and sabotage. Inventory of irradiators 4
Give a description of the source tracking system of the enterprise that ensures a continually updated inventory, with special attention to radiography outside the enterprise. Description of shielded enclosure Maximum dose rate outside the shielded enclosure: Measured Calculated Give a description of the security system. A sketch of the shielded enclosure is attached as Attachment No.: Decommissioning/disposal Describe the system for disposal of the exposure containers and gamma sources when taken out of service. Approval for maintenance of radiography equipment To what kind of equipment does the application for maintenance of radiography equipment apply? 5
Documentation regarding competence on maintenance is attached as Attachment No.: Approval for maintenance of radiography equipment procedures The procedures concerning service/maintenance of radiography equipment must be attached to the application. Procedure Date Attachment No. Date:, Signature: (for the enterprise) With capital letters: 6