FEDERAL AUTHORITY FOR NUCLEAR REGULATION
REGULATED MATERIALS LICENSEE INCIDENT REPORT
A. GENERAL INFORMATION
Name of Licensee:
Name of Licensee Contact Person:
FANR Licence Number:
Position:
E-mail:
Telephone:
B. DESCRIBE THE INCIDENT
When did it start?
Date:
Did it happen at the licensee location? Yes
and Longitude if possible)
Time:
If No, where did it happen? (Include GPS Latitude
No
What happened? (Include Licensee response)
Is the incident over?
Yes
No
If No, what is happening now?
What radioactive materials, radiation generators and/or equipment was involved?
Who was involved?
Workers
Was anyone overexposed?
Members of the Public
Yes
Was anyone physically injured?
No
Yes
Patients
How was each involved?
If Yes, describe
No
If Yes, describe
Was anyone or any part of the licensee’s facility contaminated?
Was any radioactivity released outside the facility? Yes
Yes
No
No
If Yes, describe
If Yes, describe
REGULATED MATERIALS LICENSEE INCIDENT REPORTING INSTRUCTIONS
This Form should be used by Federal Authority for Nuclear Regulation (FANR) Regulated Materials
licensees to report an Incident to FANR as required by Licence Condition 7. The requirements in
Licence Condition 7 are:
4 HOUR REPORTS - The Licensee shall notify FANR as soon as possible, but not later than 4 hours after:
a. The discovery of a loss of a radioactive source;
b. An event that requires immediate protective actions necessary to avoid exposures to radiation or Regulated
Materials that could exceed regulatory limits; or
c. Releases of Regulated Material that could exceed regulatory limits (events may include theft, road Accidents,
fires, explosions).
24 HOUR REPORTS - The Licensee shall notify FANR within 24 hours after the discovery of any of the following
events involving Regulated Material:
a. An unplanned contamination event that requires access to the contaminated area to be restricted for more
than 24 hours by imposing additional radiological controls or by prohibiting entry into the area;
b. An event in which equipment is disabled or fails to function as designed when the equipment is required to
prevent releases or exposures exceeding regulatory limits, or to mitigate the consequences of an Accident,
and no redundant equipment is available and operable to perform the required safety function;
c. An event that requires unplanned medical treatment at a medical facility of an individual with spreadable
radioactive contamination on the individual's clothing or body;
d. An Accident, fire or explosion that damages any Regulated Material or any device, container, or equipment
containing Regulated Material and the damage affects the integrity of the Regulated Material or its
container; or
e. An event where a dose limit is exceeded or has potential of being exceeded.
7 DAY REPORTS - The Licensee shall notify FANR within seven days after the discovery of any of the following
events involving Regulated Material:
a. Any discharges exceeding the authorized limits of discharge in accordance with reporting criteria established
by the Authority;
b. Any significant increase in dose rate or content of radionuclides in the environment that could be attributed
to their authorized practice.
When this form is completed, it should be submitted to the Radiation Safety Department at FANR by
email or FAX. Licensees should also call to confirm that FANR has received the form.
Email address: RM.ER@fanr.gov.ae
FAX number:
+971 2 651 6661
Confirming telephone number:
+050 641 6533
MEDICAL LICENSEES: In addition to the above reporting requirements, FANR Regulation 24 Article (41)
requires you to investigate certain unintended or Accidental Medical Exposures, and to submit a
report within 30 days to FANR and to relevant health authorities. That Article also specifies the
information required in that report.