M:\SV_SHARE\TREVOR\RADWORK\BYEMAIL\WORKFMX-2004.doc

University of Sheffield

HEALTH & SAFETY

REGISTRATION OF WORK THAT WILL INVOLVE THE USE OF X_RAY MACHINES OR OTHER ELECTRONIC EQUIPMENT CAPABLE OF PRODUCING IONISING RADIATIONS

Any electronic tube operated at potentials above 5000 volts must be considered a possible source of ionising radiations. Any person intending to acquire any item of equipment using such a tube, or a conventional x-ray machine, must complete the following form and submit it to Safety Services. The equipment should not be used until written approval has been obtained.

Persons who are already in possession of a certificate of approval for a particular work programme, but who intend to modify it, or the manner in which it is used, in any way that may increase the radiation dose should also complete the form stating the certificate number and then, against the relevant section below, enter details of the changes proposed. An amendment or further certificate of approval must be obtained before proceeding further.

1. Department
2. Previous Certificate No. if applicable

3. Description of Equipment

Make
Model & S/N
Fixed or Portable?

4. Justification and purpose of use

Use of ionising radiations must be justified. Alternative techniques should be investigated. Cost can be a justification provided the risk from radiation exposure is low.

We need to use x-rays because:

5. Tube operating conditions

Normal / mA / kV
Max. possible / mA / kV

6. Commencement and Personnel

When is it proposed to start?
Name of person who will be responsible for work*
Names of persons who will be engaged on this work.
Place where equipment will be used.
Estimate use of equipment (hours/week)
Will other persons have regular access to the laboratory(s) in which the work is carried out?

*The responsible person identified here will be the work certificate holder who will have training responsibilities: to ensure that any person working under this certificate has been adequately trained in the techniques and procedures required; and to ensure that those persons understand the precautions to be taken to minimise the exposure to ionising radiations both of themselves and others.

Form completed by

Please return this completed form to:- with a copy to your DRPS