EHS-04-D07-M01a2 - Rev 01- Internal Audit - Service - Brachytherapy (on-site) - Italy only

• Site conducted

• Conducted on

  Date

• Prepared by

• Location
  Address

• Field Engineer

• Equipment

• Others people present at audit

• Tasks performed

• Documentations

• Document number

• a) The Safety doc is present and signed by Varian and Customer (PSC, POS, DUVRI)

  Select DUVRI Informativa rischi introdotti ex art 26 Riunioni di cooperazione e coordinamento ex art.26 Coordinamento delle misure di radioprotezione ex art 112 -113 d.gls 101/2020 PSC POS Altra documentazione H&S predisposta dal committente None of the above

  • DUVRI
  • Informativa rischi introdotti ex art 26
  • Riunioni di cooperazione e coordinamento ex art.26
  • Coordinamento delle misure di radioprotezione ex art 112 -113 d.gls 101/2020
  • PSC
  • POS
  • Altra documentazione H&S predisposta dal committente
  • None of the above

• a) Customer officer is present (supervisor, health physicist, doctor ect.)

  Yes

  Partial

  No

  N/A

• b) Toilet/restroom are present and in good condition

  Yes

  Partial

  No

  N/A

• c) The environmental conditions are acceptable (temperature, light, humidity, noise, dust, etc)

  Yes

  Partial

  No

  N/A

• f) Customer safety signs are present

  Yes

  Partial

  No

  N/A

• g) The Bunker (with the exception of working material) is clear and the machine is cleaned

  Yes

  Partial

  No

  N/A

• e) Hand over (Clear hand-over at end of work & communication with site physicist of work performed & any impact on rad safety (interlocks/warnings/shielding/radiation parameters)

• a) In the Bunker no other workers are present. Exceptions are mentioned in PSC o DUVRI

  Select Only Varian personnel is present Presence of personnel from other companies

  • Only Varian personnel is present
  • Presence of personnel from other companies

• List H&S documents to manage the interferences present

  Select DUVRI Verbali riunione di cooperazione e coordinamento EHS-03-P05-M10-Rev 01 Verbale di coordinamento None of the above

  • DUVRI
  • Verbali riunione di cooperazione e coordinamento
  • EHS-03-P05-M10-Rev 01 Verbale di coordinamento
  • None of the above

• b) Demarcation & access control to Controlled Areas, safety signs are present (Area should clearly indicate Varian is in control & FSE must approve any access)

  Yes

  Partial

  No

  N/A

• List the safety signs present

  Select No access sign at bunker entrance (corridor) Radiation safety sign at bunker entrance (corridor) Safety sign at console area At least one of the above is missing

  • No access sign at bunker entrance (corridor)
  • Radiation safety sign at bunker entrance (corridor)
  • Safety sign at console area
  • At least one of the above is missing

Worker(s)

• Field Engineer name:

• a) The field engineer has his own Varian badge with photo

  Yes

  Partial

  No

  N/A

• b) The tools are in good condition (visually checked for damage, DVM , cables ...)

  Yes

  Partial

  No

  N/A

• c) The PPE is available

  Yes

  Partial

  No

  N/A

• List of PPE available

  Select Safety shoes EN 345 (S1P) Electrical safety gloves CEI-EN 60903 Class 00 Mechanical gloves EN 388 Chemical/biological gloves EN 374 (nitrile) Chemical gloves EN 374 abc (polyethylene) Safety glasses EN 166 Semi-Mask EN 149 - FFP2 Semi-Mask with filters EN 149 - A2P2 Ear plug EN 352.2 Helmet Dosimeter whole body Dosimeter extremity Surgical mask See Brachytherapy

  • Safety shoes EN 345 (S1P)
  • Electrical safety gloves CEI-EN 60903 Class 00
  • Mechanical gloves EN 388
  • Chemical/biological gloves EN 374 (nitrile)
  • Chemical gloves EN 374 abc (polyethylene)
  • Safety glasses EN 166
  • Semi-Mask EN 149 - FFP2
  • Semi-Mask with filters EN 149 - A2P2
  • Ear plug EN 352.2
  • Helmet
  • Dosimeter whole body
  • Dosimeter extremity
  • Surgical mask
  • See Brachytherapy

• PPE are in good condition

  Yes

  Partial

  No

  N/A

• d) Survey meters assigned/available & calibrated

  Yes

  Partial

  No

  N/A

• Calibration date (Calibrated within the last 12 months)

  Date

• e) Dosimeters worn, whole boby and extremity (ring) (Check name and date on dosimeter (where applicable) – is it worn correctly)

  Yes

  Partial

  No

  N/A

• f) EPD (Worn on torso facing out. Calibrated within last 12-months, 10 or 25 uSv/h warning)

  Yes

  Partial

  No

  N/A

Knowledge of procedures

• a) The field engineer has the updated EHS procedures

  Yes

  Partial

  No

  N/A

• The field engineer is aware of EHS procedures

  Select EHS-03-P01-Sorveglianza sanitaria e radioprotezione EHS-03-P04-D01-Materiale di consumo e attrezzature di lavoro EHS-03-P04-Acquisti EHS-03-P05-Gestione delle attività in appalto EHS-03-P07-Gestione rifiuti-Gestione rifiuti radioattivi EHS-03-P08-Near Miss EHS-03-P13-Sorveglianza Fisica e Sanitaria della Protezione EHS-03-P13-D01-Norme interne di radioprotezione RMT06G02-Rev 01-Instructions for Handling Radiation Emergencies with Brachy Therapy Products

  • EHS-03-P01-Sorveglianza sanitaria e radioprotezione
  • EHS-03-P04-D01-Materiale di consumo e attrezzature di lavoro
  • EHS-03-P04-Acquisti
  • EHS-03-P05-Gestione delle attività in appalto
  • EHS-03-P07-Gestione rifiuti-Gestione rifiuti radioattivi
  • EHS-03-P08-Near Miss
  • EHS-03-P13-Sorveglianza Fisica e Sanitaria della Protezione
  • EHS-03-P13-D01-Norme interne di radioprotezione
  • RMT06G02-Rev 01-Instructions for Handling Radiation Emergencies with Brachy Therapy Products

• b) The field engineer has the Customer emergency procedures

  Yes

  Partial

  No

  N/A

• c) The field engineer has the latest procedures, I-SIR updated

  Yes

  Partial

  No

  N/A

• d) The field engineer has correctly followed the steps of the procedure EHS-03-P12 - Procedura Comunicazione al Registro delle operazioni commerciali (STRIMS) Sorgenti IR192

  Yes

  Partial

  No

  N/A

• Describe the steps done

Company car

• a) Employee is aware of Company Car coverage / maintenance (company car only)

  Select Winter tyres Summer tyres High visibility vest Maintenance Emergency triangle Failed

  • Winter tyres
  • Summer tyres
  • High visibility vest
  • Maintenance
  • Emergency triangle
  • Failed

• b) First aid kit expired date check

  Date

• c) If supplied to Field Engineer, check the pressurized cans are correctly stored (WD 40, Triflow, compressed air, etc)

  Yes

  Partial

  No

  N/A

• a) Radiation Safety

• List any findings / comments / corrective actions

• Number of health and safety non-conformities

• Number of environmental non-conformities

• Overall conclusion

• Auditor Signature

  Sign

• Audidee(s) Signature

  Sign

• Other person present at audit

  Sign