LICENCE RENEWAL APPLICATION FORM
For licences expiring on 31 March 2005
Contact:
Licence Number:
Name and Address of Licensee:
Telephone No: _______________________
Fax No:
E-Mail: ___________________
_______________________
With reference to Schedules1 2 and 3 of your licence (enclosed), please ensure that the
information stated is correct. If you wish to make changes to Schedules 2 or 3, or have answered
“yes” to any of the questions below please complete the appropriate Licence Amendment
Form2 and return it with your licence renewal application.
1. Licence Cover Sheet:
Have there been any changes to the licence details
(e.g. company name, correct legal entity, address)?
Yes __
No __
Yes __
No __
Yes __
No __
Yes __
No __
2. Schedule 2: List of item(s) on Schedule 2 and location(s) where held:
Have there been any additions/removals or location
Changes in relation to the items listed?
3. Schedule 3: Personnel with responsibility for radiation protection?
Have there been any changes in personnel as listed?
4. Schedule 4: Address where licensed item(s) are kept:
Have there been any changes in the addresse(s) listed?
I believe that, to the best of my knowledge, all the sources of ionising radiation in respect of
which renewal of the licence is sought, are in a satisfactory condition3. In addition, I
undertake to ensure that the requirements relating to leak/wipe tests4, calibration of
radiation monitors5 and review of radiation safety procedures6 will be adhered to7.
Signed8
__________________________
Date ______________
I wish to apply for a renewal of the licence9.
Signed8
__________________________
Name (print or type)
__________________________
Position
__________________________
Date
______________
who is duly authorised to make this application on behalf of the licensee.
Notes
1.
Particular attention should be paid to ensuring that all radioactive substances, nuclear devices and
irradiating apparatus (X-ray machines) held are correctly described in Schedule 2 of your licence.
Holding sources which are not included on your licence represents a violation of the Radiological
Protection Act, 1991 (Ionising Radiation) Order, 2000 (S.I. No. 125 of 2000) and is subject to
penalties.
It is important to ensure that all radioactive sources having an activity or activity concentration greater
than the exemption values specified in Table A of Schedule 5 of S.I. No. 125 of 2000 are specified in
your licence.
You should ensure that the inventory of unsealed radioactive substances reflects your current usage.
If, for example, a particular radionuclide has not been used for some time and there are no immediate
plans to do so, then an amendment must be made for its removal from the licence. Similarly, many
licensees have tended to greatly overestimate the activity to be licensed so as to minimise the
possibility of having to amend their licence during the period of the licence. While this is
understandable it does distort statistics on actual radionuclide usage. Therefore, you should request a
level of unsealed radioactive substances, which is representative of your requirements.
2.
Licence amendment forms may be obtained by emailing the Regulatory Service at regulatory@rpii.ie,
downloaded from the Institute’s website (www.rpii.ie/regulation), by phoning 01-2697766 or by fax at
01-2605797.
3.
A licensee who is not in a position to make this statement in respect of any licensable item will be
issued with a licence which covers custody only of that item. The Institute may require evidence that a
licensed item has been tested and shown to be in satisfactory condition before renewing a licence for
the use of that item.
4.
For sealed radioactive sources, Article 28 (5)(a) of S.I. No. 125 of 2000 requires that a suitable
leak/wipe test is carried out to detect leakage of any radioactive substances from its container at least
once every 2 years or more frequently if recommended by the manufacturer or supplier, or if the
Regulatory Service so directs.
5.
Article 21 (3) (a) of S.I. No. 125 of 2000 requires that each monitoring instrument is calibrated before
first use and annually thereafter using sources or equipment traceable to appropriate national standards.
6.
Article 17 (3) of S.I. No. 125 of 2000 requires that the Radiation Safety Procedures be reviewed
periodically or immediately if circumstances arise where the licensee believes that any of the
operational procedures are no longer appropriate.
7.
Section 40 of S.I. No. 9 of 1991, as amended by S.I. No. 3 of 2002, states that a person who knowingly
or recklessly makes a statement which is false or misleading in a material particular when making an
application for a renewal or amendment of a licence shall be guilty of an offence.
8.
Licence renewal application forms must be signed by the Managing Director/Hospital
Administrator/Chief Executive (or equivalent member of senior management) of the establishment
making the renewal application. In the case of an application for a renewed licence in the name of an
individual person, the form must be signed by that person and the person's job title printed underneath
the signature.
9.
The fee which applies to this renewal period is detailed in the accompanying invoice. Please note that
your renewed licence will not be issued until payment of the relevant fee has been received.
March 2005