Get Ap-nt-01 Erpa Notification Form - Erpa Gov

Filling out the AP-NT-01 ERPA Notification Form is essential for notifying the Ethiopian Radiation Protection Authority about radiation practices and sources. This guide provides step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the AP-NT-01 ERPA Notification Form online.

1. Press the ‘Get Form’ button to download the AP-NT-01 ERPA Notification Form and open it for editing.
2. Begin filling in the first section with the name and address of the organization. Include details such as city or town, kebele, house number, region, postal box, office phone, mobile phone, and email.
3. In the next section, provide the name and address of the juridical person. Similar to step two, ensure to fill out city or town, region, kebele, house number, postal box, office phone, mobile phone, and email.
4. Specify the nature of the practice in which the radiation source will be used by checking the appropriate box next to the options provided, such as Dental X-Ray, Nuclear Medicine, or Industrial Radiography.
5. Indicate the origin of the radiation source by selecting one of the given options, such as ‘Purchased/Imported from abroad’ or ‘Donated from abroad’.
6. For radiation-generating devices, enter the X-Ray tube’s manufacturer, date of manufacture, model, serial number, and operating potential.
7. For radioactive sources, identify each radiation source by detailing the nature of the equipment, model (if applicable), serial number, radionuclide type, initial activity, and physical form of the radionuclide.
8. If applicable, provide information about the sealed source, including the manufacturer, model, and serial number.
9. At the end of the form, include the name and signature of the juridical/legal person, along with the date of completion.
10. After filling out all required fields, save your changes. You may download, print, or share the completed form as needed.

Complete your AP-NT-01 ERPA Notification Form online today!