The application should be completed accurately to facilitate the review of the application for approval. An incomplete application will result in unnecessary delays. The information provided will enable the University of Toronto Radiation Protection Authority (UTRPA) to provide a thorough X-ray Safety Protection program for users of these X-ray sources. The following information is required in the appropriate section of the application:
To hold a UTRPA X-ray Permit, the applicant must be, generally, one of the following:
- Assistant Professor
- Associate Professor
- Full Professor
In addition, two years of relevant experience (industrial or academic) is required and should be detailed as outlined below. If these conditions cannot be satisfied, then alternate arrangements can be made through the UTRPA. Please contact Daniel Cardenas at firstname.lastname@example.org.
- Work experience with x-ray sources; i.e., when, and where was work experience gained and the duration of the work
- Type of work previously performed; i.e., diffraction, fluorescence, materials analysis, diagnostic, dentistry, etc.
- Formal radiation protection training. Please provide brief details.
For each X-ray source please provide:
- The location (building and room number) where the x-ray source will normally be kept
- The make, model and serial number of the x-ray source
- The type of equipment (cabinet, mobile, open beam)
- The maximum operating voltage and current of the x-ray source
- The purpose for which the x-ray source will be used
- The frequency of the equipment use (hrs/week)
In addition to the above, for X-ray sources installed in a permanent location (non-mobile) please provide:
- Proposed operation starting date
- The name, position, telephone number and relevant qualifications of the person in charge of using of the permanent located X-ray source
- The anticipated maximum workload in mA*min/week
- Occupancy factor, the fraction of time the area (office, lab, hallway) will be occupied while the X-ray beam is ‘ON’ (see table below for factors)
- The usage factor is the fraction of the time the beam will be pointed in the direction indicated, as a percentage of the total time the source is on. For uncollimated panoramic or multiple beams, the sum may exceed 100%. (Open beams only)
Floor Plan Sketch:
A sketch of the laboratory must be provided with the following information along with the X-ray Permit Application Form (RPS can provide building floorplans to assist with producing the sketch):
- The proposed location of the X-ray source
- The proposed location of the X-ray Control panel, if different from that of the X-ray source
- The type and location of any safety devices such as warning lights, interlocks, and cut-off switches
- Direction of the beam and indication of “North”. (Open beams only)
MLTSD Default Occupancy Factors for completion of permit application
|Full (1)||X-ray control space, publicly accessible space, shops, corridors large enough to hold desks, living quarters, occupied space in adjoining areas, offices, laboratories, x-ray exposure switch location|
|1/2||Treatment areas, exam rooms, common work areas|
|1/5||Corridors too narrow for desks, employee lounges, staff rest rooms, stairways|
|1/20||Public restrooms, storage area, outdoor areas with seating|
|1/40||Outdoors, parking lots, crawl spaces|
Provide a brief description of the experimental procedure involving the x-ray source.
- Nature of work to be performed (e.g.: type of materials being analyzed).
- mA*min/experiment and number of experiments per year (approximate).Additional Information
Note: the UTRPA X-ray permit is valid only for experiments performed on non-human samples and specimens.
- Will undergraduate and/or summer students be working with the x-ray source requested by this permit application?
- Is a radiation monitoring instrument located in your laboratory? If so, please provide the make and model number of the instrument.
Please return the completed application to email@example.com