New Radiation Worker Registration - Ultra-Tech Laboratories

Institution

Institution Number / Temporary Institute Code * Enter the Institution Number, or the Temporary Institute Code (T...) received on submitting the institution registration.

Radiation workers can only be registered for a registered institution. Institution not registered yet? Submit the Institution Registration first - the Temporary Institute Code is generated immediately on submission.

Institution

e-Lora Registration Number (AERB Consent Ref. No.) * Not on record yet - the number entered here will be saved against the institution.

Section A — Personal Details (everything except the middle names and surname is required)

Surname (if any)

Name *

Middle Name (if any)

Photograph * (passport size, JPG/PNG, max 2MB) Required - the printed form carries this photograph.

Father's Surname *

Father's Name *

Father's Middle Name (if any)

Date of Birth *

Gender *

Place of Birth (Village/Town/City) *

State of Birth *

Sections B, C & D — Qualification, Designation & Category

Qualification

Designation

Category of Work

Section E — Nature of Work (tick all that apply)

Medical - Diagnosis: Medical - Radiation Therapy:

Teletherapy

Brachytherapy

Medical - Nuclear Medicine:

Gamma Camera

SPECT / SPECT-CT

PET-CT

PET-MR

Nuclear Medicine Therapy

Veterinary Nuclear Medicine

Medical - Others:

Foreign Institutions

Simulator

Blood Irradiators / GIC

Medical Cyclotron

Linear Accelerator

Medical Accelerator (Others)

Sealed Radiation Sources

Unsealed Radiation Sources

Industry: Research:

Research Institutes

Teaching Institutes

Veterinary Institutes

Analytical X-Ray

XRD Research

Foreign Institutions

Gamma Irradiation Chambers

Sealed Radiation Sources

Unsealed Radiation Sources

Section F — Contact, Employment & Identification

Email * (verify by OTP)

Click "Send OTP" and enter the code received on this email (check spam too).

Mobile (WhatsApp) * (verify by OTP)

Click "Send OTP" and enter the code received on WhatsApp.

Landline

Type of Employment

Nationality: Indian?

Aadhaar No. (Indian citizens) The number is checked as you type (12 digits + UIDAI check digit).

Passport No. (non-Indian)

Aadhaar Card Upload (mandatory for Indian citizens - PDF/JPG/PNG, max 5 MB)

Online Aadhaar Verification Required - any one option is enough

This form cannot be submitted until the Aadhaar is verified online (Indian citizens only - a foreign national gives a passport number instead).
Fill your name, date of birth and Aadhaar number above first - they are matched with the Aadhaar record. Only your name, date of birth, gender, address, photograph and the masked Aadhaar number reach us; the full Aadhaar number is never shared.

Option 1 With DigiLocker

Opens DigiLocker (Government of India). Sign in with the mobile number linked to your Aadhaar (OTP + DigiLocker PIN) and allow it to share your Aadhaar.

Option 2 Without DigiLocker – OTP on your mobile

No DigiLocker account needed. An OTP is sent to the mobile number registered with your Aadhaar. Enter it here and your Aadhaar details come straight from UIDAI.

Recommended - a verified application is processed faster, and the photograph from your Aadhaar is used if you have not uploaded one.

Type of ID

Company / PAN ID Card No.

Badge Requirement *

Section G — Radiation Work History

Worked with radiation in a FOREIGN institution before joining the present institution

Total Effective Dose received abroad (mSv) Attach the dose certificate with the signed form.

Worked with radiation in an INDIAN institution before joining the present institution

Prev. Institution No.

Prev. Personnel No.

From (MM/YY)

To (MM/YY)

Name of Previous Institution

Previous Institution Address

City

State

Pin Code

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 certify that the information given above is true to the best of my knowledge. The worker will always wear the Personal Monitoring badge while working in the radiation field, will not share or tamper with it, will store it away from radiation when not in use, and will report any damage, contamination or incident to the RSO / Head of the institution. The worker has undergone the required training in radiation protection and use of personal monitoring devices.