RPC - Radiation Protection Expert Approval Application

e-form

In compliance with Basic Safety Standards for Ionising Radiation Regulations, SL 585.01

Name of applicant

New applicant

Re-Approval

Cert. No:

Home Address

Telephone

Mobile

Email

Work Details

Company Name

Address

Telephone

Mobile

Email

Area for which applicant seeks approval as Proposed Radiation Protection Expert

Application Expert Area

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

Requirement 2: Continued Active Employment

A Radiation Protection Expert needs enough experience in the practice area that the individual is seeking approval.

Such employment must have covered the minimum number of years outlined in the Guidance document (DOC 53) and must be related to radiation work.

List the total number of months of active employment in a radiation related area by adding all the months in active employment claimed in the positions below

Months

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

Start Date

End Date

Total Time (Months)

Facility Name

Facility Address

Provide a summary of the work performed during this engagement

Employer Contact Name

Employer Telephone

Position No 2

Dates of Employment

Start Date

End Date

Total Time (Months)

Facility Name

Facility Address

Employer Contact Name

Employer Telephone

Provide a summary of the work performed during this engagement

Position No 3

Dates of Employment

Start Date

End Date

Total Time (Months)

Facility Name

Facility Address

Provide a summary of the work performed during this engagement

Employer Contact Name

Employer Telephone

Position No 4

Dates of Employment

Start Date

End Date

Total Time (Months)

Facility Name

Facility Address

Employer Contact Name

Employer Telephone

Provide a summary of the work performed during this engagement

I hereby attest the foregoing occupational summary record to be a true account of my work experience. The RPC has my consent to make inquiries as necessary to verify my claimed occupational activities.

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 not related to medical exposures.
3.2 Development of Radiation safety programme implemented in 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.
3.5 Documented design of new facilities.
3.6 Workplace, environmental and individual monitoring.
3.7 Waste management.
3.8 Direct responsibility of Radiation Protection at a facility.
3.9 Performing RP Risk Assessment per practice area.
3.10 Performing a RP Safety Audit.
3.11 Emergency response preparations.
3.12 Accident and incident investigation.
3.13 Training of exposed workers.
3.14 Supervision and mentoring of staff.
3.15 Preparation and delivery of formal lectures or seminars, first presentation.
3.16 Repeat delivery of formal lectures or seminars.
3.17 Publication of an RP related paper in a recognised scientific journal.
3.18 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.

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.

3l

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

If successful I consent to have my contact details (phone & email address) included on a list of Approved Radiation Protection Expert which will be made available on the RPC's website

Note: In accordance with the published Criteria for RPE Approval your name and area of expertise will be listed in the publicly available register on the RPC website.

Declaration of the Applicant

Name and Surname

ID Card

Position

Telephone

Mobile

Email

Date

This page must be printed when filled, signed, 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.

APPENDIX 1

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.

A. Regulatory Learning

Max per year

Max per
5 years

Max % of total points in 5 years

i: Attending and passing a formal examined radiation safety course within the last 5 years (per hour)

8

20

10%

B: Attendance at Conferences / Seminars / Meetings

1 Attendance at international radiological meeting
2 points per hour

15

25

20%

2 Attendance at national radiological meetings of professional societies. 1 point per hour

4

10

3 Attending a radiation related course/workshop organised within an undertaking. 0.5 point per hour

4

10

4 Online virtual real-time radiation related meeting or presentation. 0.5 point per hour

4

10

5 Planned self-directed radiation related learning, e.g computer-based e-learning. 2 points per topic

10

2

6 Visits to overseas departments for special training. 4 points per day

20

2

12

7 Membership of medical physics related body, committee, working group or official sub-committees. 2 points per year

10

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

2

10

C: Practice

1 Documented advice to undertaking on regulatory obligations not related to medical exposures. 2 points per documented activity

4

20

50% of Section C

2 Development of Radiation safety programme. 10 points per complete radiation safety programme developed

10

30

3 Documented example of the development of safety culture within an organisation. 2 points per documented activity

4

12

C: Practice

Max per
year

Max per 3 years

Minimum % of total points in 5 years

4 Documented example of optimisation of the radiation protection 2 points per documented activity

8

24

50% of Section C

5 Documented design of new facilities.. 4 points per facility

4

12

6 Workplace, environmental and individual monitoring. 2 points per documented advice/analysis of results.

4

12

7 Waste management
2 points per documented advice

4

12

8 Direct responsibility of Radiation Protection at a facility
4 point per assignment of responsibility.

8

24

9 Performing RP Risk Assessment per practice area. 2 point per initial risk assessment. 1 point per adapting existing risk assessment

4

20

10 Performing a RP Safety Audit
5 point per Safety Audit

10

20

11 Emergency response preparations
2 points per documented activity

4

20

12 Accident and incident investigation.
4 points per investigation

8

20

13 Training of exposed workers.
1point per contact hour

4

20

14 Supervision and mentoring of staff. 2 points per 8 contact hours with 1 or more staff member(s)

6

18

15 Preparation and delivery of formal lectures or seminars, first presentation, 4 points per development and delivery of 1 hour lecture

8

16

16 Repeat delivery of formal lectures or seminars.. 0.5 points per hour of repeat delivery

2

10

17 Publication of an RP related paper in a recognised scientific journal. Lead author=50 pts Co-author= 50pts/number of authors)

50

18 Oral or poster presentation on a radiation protection,
10 points for oral presentation at international event
5 points for poster presentation at international event
5 points for oral presentation at national event
2 points for poster presentation at national event

50