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27h Radiography Permit

This document is a radiography permit request form containing sections to provide details of the proposed radiography work. It requires information such as the contractor, dates, location, equipment details, names of radiography personnel and their qualifications. It also has checklists to verify required documentation and equipment are in place to ensure safety requirements are met before radiography can commence.

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Mohammed Minhaj
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741 views1 page

27h Radiography Permit

This document is a radiography permit request form containing sections to provide details of the proposed radiography work. It requires information such as the contractor, dates, location, equipment details, names of radiography personnel and their qualifications. It also has checklists to verify required documentation and equipment are in place to ensure safety requirements are met before radiography can commence.

Uploaded by

Mohammed Minhaj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Radiography Permit/Request: Form used for requesting radiography with sections for applicant details, safety checklists, and approval.

Yansab ATTACHMENT H

RADIOGRAPHY PERMIT/REQUEST
Permit No.

SECTION 1: To be completed by the contractor requesting the radiography


Contractor requesting permit: NDE Contractor:
Date requested: Date required
Proposed start time: Proposed finish time:
Location of radiography: Equipment/line number:
Print Name: Signature:
A PLOT PLAN INDETIFYING THE PROPOSED WORK LOCATION MUST BE ATTACHED TO THE PERMIT
SECTION 2: To be completed by the NDE contractor's level II radiographer
Names of technician(s) NDE level Badge No Alarm No Dosimeter (0-200 mr/h)
Start Finish

Name of level II radiographer: Signature:


A MINIMUM OF TWO AUTHORISED/CLASSIFIED OPERATIVES MUST BE IN ATTENDANCE
SECTION 3: To be completed by level II radiographer & verified by safety department prior to start
Documentation Checklist Yes No Comments
Radiation Safety Certificate
Decay Chart
Radiation Safety Manual
Emergency Telephone Numbers:
SECTION 4: To be completed by level II radiographer & verified by safety department prior to start
Equipment Checklist Yes No Comments
Survey Meter
Collimator
Radiation Warning signs
Audible warning devices
Warning tape/rope
Tongs
Extra shielding
Camera manufacturer: Serial No:
Type of Isotope: Curies:

Total Exposure Time Start Time: Finish Time:


APPROVAL
QA/QC Department Signature:

Safety Department Signature:

General Superintendent Signature:

The perimeter of the 'radiation area' must be roped off and have 'warning signs' placed at 20 meter intervals
along the perimeter and at each entrance into the area. The 'radiation area' must be clear of all none
classified personnel prior to each exposure and must be under visual surveillance during each exposure.
Prior to use all equipment is to be inspected and after each exposure both the camera and guide tube are
to be surveyed ensuring the source is in the shielded position. The radioactive source shall not be left
unattended.
Radiography will not commence until all safety requirements have been confirmed.

27h-Radiography-Permit.xls

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