Ownership Registration Of Radiation Equipment Form
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1
2GOVERNMENT OF
NEWFOUNDLAND AND LABRADOR
SERVICE NL
OCCUPATIONAL HEALTH AND SAFETY DIVISION
APPLICATION FOR
OWNERSHIP REGISTRATION OF RADIATION EQUIPMENT
The Radiation Health and Safety Act
Registration No: ____________________________
(Chapter R-1)
NOTE:
Please type or print
Department of Service NL
Insert X where applicable
Occupational Health and Safety Division
on blank line or in box
P.O. Box 8700, St. John’s, NL
Complete and return this form to:
A1B 4J6
Under the Radiation Health and Safety Regulations, Section 5, the undersigned as owner ___ Or as
Agent for the owner ____ of radiation equipment applies for registration with the Occupational
Health and Safety Division. Each location will require a separate application.
NOTE:
If this equipment has been previously registered, enter Registration
No., owner and any change to previous information only.
A.
The radiation equipment is located at:
Number, Street _____________ Suite No. ___________ Telephone No. _______________
City: _____________________________________________Postal Code: _________________
B.
The individual responsible for safe use of equipment is: ________________
Number, Street _____________ Suite No. ___________ Telephone No. _______________
City: _____________________________________________ Postal Code: ________________
Business address is at “A” _____ or is:
Number, Street _____________ Suite No. ___________ Telephone No. _______________
City: ____________________________________________ Postal Code: ________________
Business address is at “B” _____ or is:
Number, Street: ________________________________________________________________
Business Address: __________________________________ Telephone No. ______________
City: _______________________________________________Postal Code: ______________
C.
The owner of the premises in which the radiation equipment is (are)
located is the same as “A” _____ or “B” _____ or is
Number, Street: ________________________________________________________________
Business Address: ____________________________________Telephone No. _____________
City: _______________________________________________ Postal Code: ______________
D:
The general nature of the owner’s business is:
□
□
Education &
□
C
Chiropractic
E
D
Dental
Training
Industrial &
□
□
□
H
Hospital/Clinic
I
O
Other
Commercial
Research &
Food
□
□
□
V
Veterinary
R
F
Development
Inspections
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