RPC - Medical Physics Expert Approval Application
In compliance with Basic Safety Standards for Ionising Radiation Regulations, SL 585.01
Personal Details
Home Address
Work Details
Company Name
Email
Application for which applicant seeks approval as Medical Physics Expert
Medical Physics Expert Area
Certificate No.
Requirement 2: Continued Active Employment
A Medical Physics Expert needs a minimum of 48 months experience in the preceding 60 months and post the award of the MSC certificate, in the practice area that the individual is approved for.
List the total number of months of active employment in a radiation related area by adding all the months in active employemnt claimed in the positions below.
Summary of Work Engagements
Use the following pages as necessary to document your continuing active employment. This can also include any part time work. For each engagement, you are required to name an individual who can supply verification of occupational activities and has knowledge of your job functions. Note: For part time work, 1 month is equivalent to 170hrs
Position No 1
Dates of Employment
Provide a summary of the work performed during this engagement
Position No 2
Dates of Employment
Provide a summary of the work performed during this engagement
Position No 3
Dates of Employment
Provide a summary of the work performed during this engagement
Position No 4
Dates of Employment
Provide a summary of the work performed during this engagement
Requirement 2: Points
The demonstration of an effort to keep up to date, contribute to knowledge, or maintain continued growth in the areas the individual is approved in, by obtaining the minimum points required in document DOC 53, by engaging in one or more of the seven categories below.
Supporting documentation is required for all points claimed. All supporting documentation shall be keyed by section number to the proper section of the application and attached to the back of this application.
A. Regulatory Learning Activities
Attending a national meeting on radiation protection legislation in Malta that has been notified to the Commission
Appropriate documentation: Attendance certificates.
Notes on filling in the details below:
Document Number: The number written down should be marked on the verification document/s supplied
Training Course: The name of the training course or workshop
Document Description: State what kind of document is being attached eg. Certificate of attendance, examination result, letter of verification etc
Number of Points: Write the number of points from the list provided in Annex 1 for each activity
Doc No.
1a
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
1b
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
1c
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
1d
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
1e
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Total Points for this Category
B. General Learning Activities
2.1 Attendance at international, radiological meeting
2.2 Attendance at national radiological meetings of professional societies
2.3 Attending a radiation related course/workshop organised within an undertaking
2.4 Online virtual real-time radiation related meeting or presentation
2.5 Planned self-directed radiation related learning, e.g computer-based e-learning.
2.6 Visits to overseas departments for special training
2.7 Membership of radiation protection related body, committee, working group or official sub-committees
2.8 Formal non-radiation safety related on the job training activities and experiences e.g. development of interpersonal skills, time management etc.
Appropriate documentation: attendance certificates, pass certificates of examination taken during courses, letters of enrollment etc.
Notes on filling in the details below:
Document Number: The number written down should be marked on the verification document/s supplied.
Document Description: The name of the conference, seminar or meeting attended.
Document Description: State what kind of document is being attached, eg. Certificate of attendance, examination result, letter of verification etc.
Number of Points: Write the number of points from the list provided in Annex 1 for each activity.
Doc No.
2a
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2b
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2c
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2d
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2e
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2f
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2g
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2h
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2i
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2j
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2k
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2l
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
2m
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Total Points for this Category
C. Practice Activities
3.1 Documented advice to undertaking on regulatory obligations related to medical exposures.
3.2 Documented contribution to the development of the radiation protection programme within an organisation.
3.3 Documented example of the development of safety culture within an organisation.
3.4 Documented example of optimisation of the radiation protection of patients and other individuals subject to medical exposure, including the application and use of diagnostic reference levels.
3.5 Development of quality assurance programmes of the medical radiological equipment.
3.6 Development of testing protocols for medical radiological equipment.
3.7 The preparation of technical specifications for medical radiological equipment and installation design.
3.8 Development of new technique in medical exposure.
3.9 Incident report of events involving, or potentially involving, accidental or unintended medical exposures.
3.10 Training of practitioners and other staff in relevant aspects of radiological aspects of medical exposures.
3.11 Preparation and delivery of formal lectures or seminars, first presentation.
3.12 Repeat delivery of formal lectures or seminars.
3.13 Supervision and mentoring of physics staff .
3.14 Publication of an RP related paper in a recognised scientific journal.
3.15 Oral or poster presentation on a radiation protection.
Appropriate documentation:
The first page of the article or paper is adequate, provided that the title, the author(s), name(s) and the name and date of the publication appear. Official membership certificate, letters of appointment etc.
Doc No.
3l
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3a
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3b
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3c
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3d
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3e
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3f
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3g
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3h
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3i
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3j
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3k
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Doc No.
3m
Event
Training Course Name, Meeting. etc.
Cat. No.
Document Description
No. of Points
Total Points for this Category
Documented Evidence attached to this Application
Section
A
Total No. of Documents
Total No. of Sheets
Section
B
Total No. of Documents
Total No. of Sheets
Section
C
Total No. of Documents
Total No. of Sheets
DECLARATION OF CONSENT FOR CONTACT DATA TO BE AVAILABLE PUBLICLY
Note: In accordance with the published Criteria for MPE Approval your name and area of expertise will be listed in the publicly available register on the RPC website.
Declaration of the Applicant
This form must be printed when filled, signed below, uploaded as an attachment and submitted to the Commission via email ( info.rpc@gov.mt ) or by other means to address below.
Signature
Send completed form to Radiation Protection Commission at Sorbonne Centre, Unit F22, Mosta Technopark, Mosta
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.
The list below outlines three (3) different activities that, if carried out, will award points towards the Continuing Professional Development of an individual aspiring as a Radiation Protection Expert or for subsequent re-approval. An individual will have to meet the number of points required for each practice as listed in document EQ/INF/1.
An individual approved as a Radiation Protection Expert in one (1) area of practice and who wishes to become approved in another area can use the number of points acquired in the approved practice area towards her/his application in another practice area. Similarly, an individual applying for multi practice area, will only need the number of points of that practice area that carries the maximum number of CPD points.
Minimum points in 5 years
Minimum points in 5 years
i: Attending and passing a formal examined radiation safety course within the last 5 years (per hour)
The list below outlines three (3) different activities that, if carried out, will award points towards the Continuing Professional Development of an individual aspiring as a Radiation Protection Expert or for subsequent re-approval. An individual will have to meet the number of points required for each practice as listed in document EQ/INF/1.
An individual approved as a Radiation Protection Expert in one (1) area of practice and who wishes to become approved in another area can use the number of points acquired in the approved practice area towards her/his application in another practice area. Similarly, an individual applying for multi practice area, will only need the number of points of that practice area that carries the maximum number of CPD points.
B: Attendance at Conferences / Seminars / Meetings
1: Attendance at international radiological meeting
2 points per hour
2:Attendance at national radiological meetings of professional societies. 1 point per hour
1: Attendance at international radiological meeting
2 points per hour
3: Attending a radiation related course/workshop organised within an undertaking. 0.5 point per hour
1: Attendance at international radiological meeting
2 points per hour
4 Online virtual real-time radiation related meeting or presentation. 0.5 point per hour
1: Attendance at international radiological meeting
2 points per hour
5: Planned self-directed radiation related learning, e.g computer-based e-learning. 2 points per topic
1: Attendance at international radiological meeting
2 points per hour
6 Visits to overseas departments for special training. 4 points per day
1: Attendance at international radiological meeting
2 points per hour
7 Membership of medical physics related body committee working group or official sub-committees. 2 points per year
1: Attendance at international radiological meeting
2 points per hour
8 Formal non-radiation safety related on the job training activities and experiences, e.g. development of interpersonal skills, time management etc. 1 point per topic
1 Documented advice to undertaking on regulatory obligations not related to medical exposures. 2 points per documented activity
2 Development of Radiation safety programme. 10 points per complete radiation safety programme developed
1 Documented advice to undertaking on regulatory obligations not related to medical exposures. 2 points per documented activity
3 Documented example of the development of safety culture within an organisation. 2 points per documented activity