Annual Compliance Reporting Form Page 3
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4940E
PROTECTED WHEN COMPLETED
8.
Inventory
Provide detailed information for all:
•
radiation devices containing sealed sources; and
•
sealed sources that are not contained in radiation devices.
Device
Sealed Source or Sealed Source Assembly
Authorized
b
Location
a
The activity of the nuclear substance in the sealed source or sealed source assembly on the reference
date (date when the activity was measured or source calibrated).
b
The address of the location authorized by the CNSC where the sealed source (whether in or outside of
the device) resides at the time of the report. In the case of field operations with sealed sources, enter the
storage location.
9.
Radiation Protection Program
Provide information on any changes made to the radiation protection program, including changes
to policies or procedures, on a separate sheet and submit it with this report.
10.
Incidents and Unusual Occurrences
List all incidents and unusual occurrences not previously reported to the CNSC during the reporting
period
Date of event
Type of event
Nuclear substance
Radiation device or prescribed
(if applicable)
equipment (if applicable)
Page 3 of 4
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