Title Page

Operational Audit (Bi-Annual)

  • Clinic Location

  • Room No.

  • Type of Laser Equipment

  • Date of Audit

Operational Audit (Bi-Annual)

Licence & Conditions

  • Is the possession licence appropriate for the radiation practices conducted?

  • Is the possession licensee complying with the condition stated on the license?

Laser Safety Officer

  • Has the person who holds a relevant Laser Safety Officer Certificate been appointed as LSO?

  • Date of Attainment

  • Has the LSO been carrying out the functions stated in the RSPP?


  • Do the radiation sources/apparatuses and their locations math the inventory?


  • Does each apparatus in use have a current certificate of compliance and do they remain in compliant with the relevant standard?

  • Date of Certificate

  • Does each premise have a current and appropriate certificate of compliance and do they remain in compliance with the relevant standard?

  • Date of Certificate

Radiation Safety and Protection Plan (RSPP)

  • Is there a RSPP appropriate for the radiation practice?

  • Do users have access to the RSPP?

  • Is access to, or use of radiation apparatuses adequately controlled?

Use of apparatuses

  • Are safety checks / QA checks conducted as described in the RSPP?


  • Are all records required by the RSSP being maintained?


  • Is transport of radioactive substance carried out by licensed persons authorised under the act if applicable?

Supply of Safety Devices

  • Are safety devices supplied, used and checked as described in the RSPP?

Supply of Personal Protective Equipment

  • Is personal protective equipment supplied and checked as described in the RSPP?

Integrity of Personal Protective Eyewear

  • No sign of pitting, grazing, cracking and discoloration of material?

  • No damage to straps, frame and retaining devices?

  • No light leaks and coating damage?

Supply of Radiation Monitoring Equipment

  • Is equipment supplied used, checked and calibrated as described in the RSPP?

Additional Notes

  • Notes:

Non-conformance Details

  • Details:


  • Name of Auditor:

  • Signature:

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