DATJ 199 Radiation Controlled Area and Equipment Handover Form - duplicate

• Site conducted

  Select

• Business unit

  Select

• Conducted on

  Date

• Prepared by RPS

• Controlled Location
  Address

• Equipment reference number

• Part 1: To be completed by Schenker Ltd RPS – Handover of controlled area and equipment to Approved Maintenance Company

FACILITY / DEPARTMENT: Gateway/ Air Warehouse Heathrow

MAINTENANCE COMPANY CARRYING OUT WORK:

• Company Name

• Company Representative

EQUIPMENT:

• REASON FOR HANDOVER

• ID SEEN (take Image of ID)

  Yes

  No

• CALL REFERENCE NO:

IDENTIFY KNOWN HAZARDS WITH CONTROLLED AREA OR EQUIPMENT:

• Schenker Ltd: As a Radiation Protection Supervisor (RPS) of Schenker Ltd, I hereby hand over the controlled area and equipment as above. Information has been exchanged to enable appropriate risk assessment to be made

• Maintenance Company: As an appointed representative of the Maintenance Company, I accept responsibility of the controlled area and equipment for the reason stated above. Risk assessment will be made using the information provided and Maintenance Company procedures followed

• Name of Schenker Ltd Radiation Protection Supervisor (RPS):

  Sign

• Maintenance Company Representative:

  Sign

• Part 2: To be completed by maintenance company representative – Handover of controlled area and equipment to Schenker Ltd. Please tick all applicable categories of work carried out

CATEGORY OF WORK

• What Type of work is being completed?

  Routine Service

  Fault diagnosis/ repair

  Installation of Parts

  Hardware/ Software

• What is the purpose of the installation of parts

  Upgrade

  Modification

† Incident response

• What was the incident response?

  Select Hazard Notice Response Protocol Changes Other

  • Hazard Notice Response
  • Protocol Changes
  • Other

• As response is other, please enter details

• Could this work have implications for radiation safety or image quality?

  Yes

  No

  N/A

• Tick all boxes that apply

  Select Sheilding Image quality/ processing Interlocks/ exposure termination Mechanical/ Electronic/ Scale Cal Safety Features/ Warning Devices Collimation/ alignemnt/field sizes Detector dose/ dose indicator

  • Sheilding
  • Image quality/ processing
  • Interlocks/ exposure termination
  • Mechanical/ Electronic/ Scale Cal
  • Safety Features/ Warning Devices
  • Collimation/ alignemnt/field sizes
  • Detector dose/ dose indicator

• See visit/service report for details

• Work is completed and the equipment is:

  Select OPERATIONAL following work as indicated above and, on the visit / service report PARTIALLY OPERATIONAL limitations may exist, refer to the visit / service report NOT OPERATIONAL and MUST NOT BE USED

  • OPERATIONAL following work as indicated above and, on the visit / service report
  • PARTIALLY OPERATIONAL limitations may exist, refer to the visit / service report
  • NOT OPERATIONAL and MUST NOT BE USED

Schenker Ltd RPS:

• Date and Time handed back to Schenker Ltd:

  Date

• Part 3: SCHENKER LTD – Returning equipment to use I confirm that I have been appointed as a competent Schenker Ltd (RPS).

• I confirm the above Maintenance Company provided information, associated service report and carried out appropriate checks in accordance with the Ionising Radiation Regulations 2017. I confirm all required local procedures have been completed and have reviewed the service report

• Result of compelted maintenance

  Select I am satisfied that the equipment is in a satisfactory condition for use in cargo inspection/exposure I am NOT satisfied that the equipment is in a satisfactory condition for use in cargo inspection/exposure

  • I am satisfied that the equipment is in a satisfactory condition for use in cargo inspection/exposure
  • I am NOT satisfied that the equipment is in a satisfactory condition for use in cargo inspection/exposure

• What are reasons for non-satisfaction?

• Add actions to this to ensure followed up

• Schenker Ltd RPS acceptance sign off

  Sign