Get the free IONISING RADIATION INCIDENT REPORT FORM - healthgovtnz

Office of Radiation Safety ORS Ionizing RADIATION INCIDENT REPORT FORM FOR ALL INCIDENTS EXCEPT FOR THOSE INVOLVING PATIENT EXPOSURES SOURCE OWNER/EMPLOYER AND LICENSEE DETAILS Owners/employers name:

How to fill out ionising radiation incident report

How to fill out an ionising radiation incident report:

1. Provide your personal and contact information - This includes your name, job title, contact number, and email address. It is important to have accurate contact details so that the relevant authorities can reach out for further clarification if needed.
2. Indicate the date, time, and location of the incident - Specify the exact date and time when the incident occurred, as well as the specific location where it took place. This information helps in accurately documenting the incident and conducting any necessary investigations.
3. Describe the incident in detail - Provide a comprehensive description of what happened during the incident. Be sure to include information such as the type of ionising radiation involved, any equipment or materials that were being used, and any observable effects or consequences of the incident.
4. Identify any individuals affected or involved - List the names and job titles of all individuals who were present or affected by the incident. This includes both personnel directly working with ionising radiation and any bystanders who may have been exposed.
5. Document any injuries or damage - If there were any injuries or damage resulting from the incident, clearly outline the nature and extent of these effects. Include any medical treatment provided or required for the affected individuals.
6. Outline the actions taken or required - Describe any immediate actions that were taken to mitigate the incident and prevent further harm. Additionally, specify any follow-up actions that need to be implemented, such as equipment inspection, training, or policy revisions.
7. Attach supporting documents or evidence - If there are any relevant documents, photographs, or records related to the incident, make sure to attach them to the report. These can provide additional context or evidence to support the investigation and analysis of the incident.

Who needs an ionising radiation incident report?

1. Radiological safety officer - The RSO is responsible for overseeing radiation safety within an organization and addressing any incidents that occur. They need the incident report to assess the situation, implement corrective actions, and ensure compliance with regulatory requirements.
2. Health and Safety Department - The health and safety department within an organization requires the incident report for tracking and monitoring purposes. It allows them to identify trends, evaluate risk levels, and take proactive measures to prevent similar incidents from occurring in the future.
3. Regulatory authorities - Depending on the jurisdiction, regulatory bodies overseeing radiation safety may require organizations to submit incident reports. These reports help the authorities to identify potential safety hazards, enforce regulations, and ensure the protection of individuals and the environment.

In summary, an ionising radiation incident report should be filled out accurately and in detail, providing information about the incident, individuals involved, actions taken, and any required follow-up measures. This report is essential for radiological safety officers, health and safety departments, and regulatory authorities to effectively address incidents and promote radiation safety.

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