Ultra-Tech Laboratories Pvt. Ltd.

Application for Personnel Monitoring Services (Non-DAE / PMS)

Based on the BARC RPAD Institution Registration Form. Fields marked * are mandatory.
Section A — Institution & Contact Details
City and State fill in once six digits are entered.
Click "Send OTP" and enter the code received on WhatsApp.
Click "Send OTP" and enter the code received on this email (check spam too).
Designated Officer (Head / RSO / Site-in-charge - responsible for PM devices & dose data)
Section B — Regulatory Consent & Radiation Category
Type of Radiation for Which Monitoring is Required *
Section C — Institution Class Codes (tick all that apply)
Medical - Diagnosis:
Medical - Radiation Therapy:
Medical - Nuclear Medicine:
Medical - Others:
Industry:
Research:
Section D — Details of Radiation Applications
(i) X-ray Based Systems
Sr.
No.		 Make, Model and Type of Unit Operating Voltage (kVp) Current (mA) Fixed or Mobile Date of Procurement and Installation AERB Ref. No. for Procurement and Installation
1
(ii) Sealed Source Devices
Sr.
No.		 Details of Make, Model and Type of Unit Name of the Isotope Activity (Curie or GBq) On Date Date of Procurement and Installation AERB Ref. No. for Procurement and Installation
1
(iii) Accelerators
Sr.
No.		 Make, Model and Type of Unit Operating Voltage (kVp) / Energy (MeV) Current (mA) Output in RMM Fixed or Mobile Date of Procurement / Import and Installation AERB Ref. No. for Procurement and Installation
1
(iv) Sealed Sources
Sr.
No.		 Source & its Physical Form Activity (Curie or GBq) On Date Type of Use AERB Ref. No. for Procurement / Import of Sealed Sources
1
(v) Unsealed Sources
Sr.
No.		 Source Activity in Stock (mCi / MBq) On Date Qty Handled at a Time (mCi / MBq) Physical Form Chemical Form Activity Procured (Curie / Year) AERB Ref. No. for Procurement and Handling
1
Fill only the tables applicable to your institution; leave others blank. Give details of any other radiation generating machine or device/source not covered above on a separate sheet with the signed physical form.
Section E — PMS Requirements
A Personal Data Form for each radiation worker can be submitted from the customer portal after your registration is approved, or attached with the signed physical form.
Documents to Attach *
Signature

Signing: after submitting, download the PDF, print it in colour, sign it with stamp & seal and courier it to Ultra-Tech Laboratories Pvt. Ltd. The address is in the acknowledgement e-mail.

DECLARATION

I HAVE READ THE PM BADGE USER'S INSTRUCTION MANUAL AND THE ATTACHED TERMS AND CONDITIONS AND I UNDERTAKE TO:

  • Comply with all instructions stated in the manual and any other future instructions given by the Competent Authority.
  • Comply with the regulatory requirements for handling of radiation sources (i.e. radioactive material and radiation generating machines) stipulated by the Regulatory Body.
  • Investigate the cases of over-exposures or contamination of TLD cards and send the reports promptly whenever called for, to Head, RPAD.
  • Return the TLD / neutron badges promptly after the end of the stipulated monitoring period.
  • Ensure that TLD / neutron badges are stored in normal radiation background.
  • Ensure that Personal Monitoring badges shall be used exclusively by the worker who has been issued the badge. It shall not be issued to any other person.
  • Intimate any change in the data regarding radiation sources to the Service Provider.
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