Title Page

  • Conducted on

  • Prepared by

  • Location

Personal Responsibilities

  • Is there anybody at height above the booth (5 meters) within a distance of 5 meters of the booth?

  • Are all risk assessments and local rules available for the radiographers and easily accessible? (Not a mandatory requirement).

Actions to be Taken before Work Commences

  • Are all radiographers wearing their TLD and audible alarm?

  • Are all of the lights working?

  • Is signage for the lighting and alarms displayed on the wall?

  • Are door interlocks operational and unobstructed? Demonstrate to auditor.

  • Is the radiation dose monitor calibrated, and is the calibration in date?

  • Are there any obvious signs of damage to exposure equipment, including containers, guide tubes, drive cables ect.

  • Is the x-ray radiography carried out in its designated area?

  • Is there a record of the weekly radiation bay checks?

Actions to be Taken during Working Operations

  • Was the equipment assembled in the booth before work, and the drive cable/windout assembly or the control panel and control cable assembly outside the booth?

  • Does the radiographer stay station during each exposure to prevent unauthorized entry?

Actions to be Taken when Work is Complete

  • If gamma was used, has all exposure equipment been disassembled, locked in container and key removed? (If x-ray was used answer N/A)

  • If x-ray was used has the equipment been fully switched off and has the control panel key been removed and securely retained? (If gamma was used answer N/A)

  • When radiographers are off site, is the booth shut and locked, and the enclosure door left fully open?

  • During temporary absence is the Isotope container locked with the key removed? Is all radioactive sources locked away and switched off?

Emergency Procedures

  • Is the emergency kit accessible at all times with relevant equipment?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.