e-form

RPC - Employer’s Notification to appoint a Radiation Protection Expert

In compliance with Basic Safety Standards for Ionising Radiation Regulations, SL585.01

Employer
Name and Surname

Contact Details

Address of Practice (where Ionising Radiation Activities occur)

Telephone

Mobile

Email

Employer's Practice for which the Radiation Protection Expert is being nominated

Diagnostic Radiology

Radiotherapy

Nuclear Medicine

Dentistry

Veterinary Radiography

Non-Destructive Testing

Fixed Gauges and Fixed Screening Devices

Mobile Gauges and Mobile Screening Devices

Research with Un-Sealed Sources

Research with X-Ray Equipment and Sealed Sources

Other Application

Proposed Radiation Protection Expert

Name of Proposed Radiation Protection Expert

RPC Approval Certificate Number

Name of Proposed Radiation Protection Expert

Signature of acceptance of proposed Radiation Protection Expert

Declaration of the Employer's Legal Person

I certify that the information provided in this form is correct.

Name and Surname

ID Card

Telephone

Mobile

Email

Date

This form must be printed when filled, signed and submitted to the Commission via email ( info.rpc@gov.mt ) or by other means to address below.

Signature

Radiation Protection Commission
Sorbonne Centre
Unit F22Mosta
Technopark
Mosta MST 3000

The Radiation Protection Commission 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 fulfillment of this application. We may process your address, telephone, fax or e-mail 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.