RISK ASSESSMENT FORM
USE OF X-RAY EQUIPMENT
DEPARTMENT / UNIT
BUILDING
PERSONS INVOLVED
PROCEDURE(S) COVERED BY THIS ASSESSMENT
The purpose of this risk assessment is to restrict exposure to Users of ionising radiations and those who
by association may be exposed, e.g. co-workers, students, maintenance and cleaning staff.
equipment make/model
max kV
What is the purpose of the exposure?
imaging
irradiation
other
give details
Could another technique be used involving less or no radiation?
no
yes
Could a lower energy exposure be used?
no
yes
The assessment of risks to personnel arising from ionising radiations should be based on the potential for dose
before Controls are put in place.
state the nature of the risks below
Make an assessment of the risks:
high
medium
low
Consider, in turn, each component of the radiation work and the Controls applicable to it, ticking any relevant
Control box. Where necessary please indicate other measures you have implemented to control the risks arising
from the work, in the space provided. The higher the risk the more stringent the Control measure.
CONTROL MEASURES
Will any aspect of the work be carried out in a Controlled Area?
no
yes
room no
Will any aspect of the work be carried out in a Supervised Area?
no
yes
room no
Local Rules
I will adhere to Local Rules and Working with Ionising Radiations at UCL
no
yes
The Room or Enclosure to minimise dose from unintended exposure the following are implemented:
the room / enclosure is adequately shielded
the room / enclosure access is fitted with an interlock
an emergency stop button is provided and clearly positioned within the room
the entrance to the room / enclosure is fitted with a warning sign
other control:
indicate which of the following will be used to minimise exposure:
The Equipment
the equipment is operated by a trapped key system – to prevent accidental emission
the equipment is fitted with a means of locking off - to prevent uncontrolled use
the equipment is fitted with a safety device e.g. interlock, which will ensure that an exposure;
a) cannot commence whilst any access door is open
b) is interrupted if the access door is opened
c) does not recommence merely on closing the access door
the equipment is checked for radiation safety at least every 12 months
the equipment is always checked for radiation safety after repair or modification, by a competent person
other control:
X-ray equipment
1
May 2010
to minimise exposure to non radiation workers, the work area will make use of:
Work Area
delineated area / segregated from other work
fixed or mobile shielding
interlocks to prevent access to source room whilst X-rays are being emitted
other control:
as a means of detecting exposure the following are used:
Monitoring and Personal Dosimetry
film badges
TLDs
stray radiation is monitored for
other control:
This Section should be completed by the RPS
to ensure adequate equipment and facilities
Compliance
the department/unit has notified the UCL Co-ordinator for Ionising Radiations of this X-ray equipment
the equipment meets the requirements of Regulations 31 & 32, IRR 1999
the equipment complies with the conditions of the generic authorisation
the equipment has an identification number or distinguishing mark
the supplier is reputable, e.g. has a quality standard
other control:
with regard to the people who may come into contact with the closed source:
Personnel
those undertaking the work are authorised radiation workers
those undertaking the work are sufficiently trained
the work poses no risk to those who may be/are pregnant
maintenance workers and cleaners enter the room under ‘permit - to - work’
the work poses no risk to non radiation workers or other members of the public
other control:
Disposal
indicate which of the following disposal routes will be used
via the UCL Facilities Services
via an Authorised Contractor
state Contractors contact details
other control:
X-ray equipment
May 2010
2
DECLARATION
I the undersigned have assessed the activity and the associated risks and (delete as applicable) declare that
there is no significant risk/the risk will be controlled by the method(s) listed above. Those participating in the
work have read the assessment. The work will be reassessed whenever there is significant change and at
least annually.
NAME(S) OF USER(S)
SIGNATURE(S) OF USER(S)
DATE
REVIEW DATE
NAME OF RPS
DATE
SIGNATURE OF RPS
REVIEW DATE