RPB - Employer's Notification to Appoint a Qualified Expert
In compliance with Nuclear Safety and Radiation Protection Regulations 2003, LN 44 of 2003
EmployerName and Surname
Address of Practice (where Ionising Radiation Activities occur)
Employer's Practice for which the Qualified Expert is being nominated
Proposed Qualified Expert
Name of Proposed Qualified Expert
RPB Approval Certificate Number
Signature of Acceptance of proposed Qualified Expert
Declaration of the Employer's Legal PersonI certify that the information provided in this form is correct.
Name and Surname
The Radiation Protection Board will process your data in accordance with the principles of the Data Protection Act. We will not release any information held about you to third parties except where necessary for the fulfilment of this application. We may process your address, telephone or email details to contact you in connection with this application. Completion and submission of this application form signifies your consent to the processing of this data. Please contact us if you would like us to inform you about the personal data we hold about you or if you require such data to be corrected.
Send completed form to Radiation Protection Board (email: firstname.lastname@example.org)