Get Ionising Radiation Incident Report Form - Healthgovtnz

Completing the Ionising Radiation Incident Report Form is essential for documenting any incidents related to ionising radiation in a clear and organized manner. This guide will provide you with step-by-step instructions to help you fill out the form online efficiently and accurately.

Follow the steps to successfully complete the report form.

1. Press the ‘Get Form’ button to access the Ionising Radiation Incident Report Form and open it in your chosen editor.
2. In the section for source owner/employer details, fill in the owner’s or employer’s name and their address. Include the name and designation of the person completing the form, along with their phone number, fax number, and email.
3. Provide detailed information regarding the incident. Enter the date of the incident and the names and designations of the persons involved. Answer the question regarding whether anyone received an increased radiation dose due to this incident.
4. Detail the radiation sources involved in the incident, such as the types of equipment or radioactive sources. Indicate if any sources are not under control, and if so, specify if they are lost, stolen, or damaged.
5. Specify the physical location of the incident if it differs from the owner/employer address. Include a description of the incident, and mention any actions taken immediately following the occurrence.
6. In the incident assessment section, identify the main cause of the incident, selecting from options such as equipment failure, human error, training-related issues, inadequate procedures, process-related factors, or other specified causes.
7. Determine whether the incident could have been more serious and provide an assessment of radiation doses to the individuals involved, including any calculations.
8. Outline the steps that have been taken to prevent a recurrence of the incident and indicate whether an internal investigation is ongoing. Make sure to note that any report from the investigation should be forwarded to the Office of Radiation Safety.
9. Sign and include the name of the person completing the form at the designated area.
10. Finally, save your changes, and options will be available to download, print, or share the completed form.

Complete your documents online today to ensure timely and accurate reporting.