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Any submission in IU-6 form does not imply permission from AERB wherever necessary permission should be obtained separately. IR/IU-6 PROFORMA LOCATION DETAILS OF THE INDUSTRIAL RADIOGRAPHY EXPOSURE DEVICES Part A and B to be submitted to Head RSD AERB in the beginning of every month and Part C to be submitted once in six months regularly For Month 200 Name and address of the institution Phone No. NR Fax. No* ER PMS*No* WR No* of films/ cards received SR Part A Sites exposure devices trained personnel and monitors available on sites Sr. Sites Contract Site in-charge Source type Certified Exposure Radiographer no. Awarding party Name and his Device activity Name and his Last inspection Cert. No* with Model date its validity Sr. No* and source Cert. No* with Date of holder no. movement to this site Survey meter model Sr. No* and calibration Pocket Dosimeter Charger model and their Sr. No Trainee Name his appointment date and PMS No* Job type of during the month Note 1. 2. Part A should cover all the trained personnel and accessories. Part B Details of the Decayed Sources returned to BRIT Nos. Exposure Device Date of decayed Model Sr. No* Source return Activity on Date of return I hereby certify that all safety/ emergency accessories are available at site s they are in working order and they are being used regularly. I also certify that personnel monitoring devices are provided to all the radiation workers. Signature -----------------------------------With date ------------------------------------- Head of institution Seal Sr. Nos. Calibration Survey meter Model and Sr. No* Source type and activity used Distance from source m reading Reading expected by Calculation Deviation Note RSO is required to check the calibration of survey meters at site once in six months with decayed source and indicate in Part A col*7 regularly. No* ER PMS*No* WR No* of films/ cards received SR Part A Sites exposure devices trained personnel and monitors available on sites Sr. Sites Contract Site in-charge Source type Certified Exposure Radiographer no. Awarding party Name and his Device activity Name and his Last inspection Cert. Sites Contract Site in-charge Source type Certified Exposure Radiographer no. Awarding party Name and his Device activity Name and his Last inspection Cert. No* with Model date its validity Sr. No* and source Cert. No* with Date of holder no. movement to this site Survey meter model Sr. No* with Model date its validity Sr. No* and source Cert. No* with Date of holder no. movement to this site Survey meter model Sr. No* and calibration Pocket Dosimeter Charger model and their Sr. No Trainee Name his appointment date and PMS No* Job type of during the month Note 1. 2. Part A should cover all the trained personnel and accessories. Part B Details of the Decayed Sources returned to BRIT Nos. Exposure Device Date of decayed Model Sr. No* Source return Activity on Date of return I hereby certify that all safety/ emergency accessories are available at site s they are in working order and they are being used regularly.

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