📍 When to use this template
- Before starting any Non-Destructive Testing (NDT) involving X-ray or Gamma-ray sources.
- A new permit is required for each shift or each new location of radiography work.
- Filled by the NDT agency's Site-in-Charge/Radiographer and approved by the PMC/Client Safety Officer.
Sections & fields
Preview of the template structure. Download Excel to fill on site.
1Header / Project Information9 fields
Project Name
_____________
Contract / Package No.
_____________
Date of Request
_____________
Permit Validity (From Date/Time)
_____________
Permit Validity (To Date/Time)
_____________
Location / Grid / Chainage
_____________
Prepared By (NDT Agency)
_____________
Approved By (PMC/Client Safety)
_____________
2Radiography Agency & Personnel Details7 fields
NDT Agency Name
_____________
Radiographer Name & ID
_____________
BARC RSO Level (I/II/III)
_____________
BARC Certificate No. & Validity
_____________
Assistant Radiographer Name & ID
_____________
TLD Badge Nos. (All personnel)
_____________
Medical Fitness Certificate Validity
_____________
3Radiation Source & Equipment Details8 fields
Source Type (e.g., Iridium-192, Cobalt-60, X-Ray)
_____________
Source Serial Number
_____________
Source Activity (in Curies/Bq)
_____________
AERB License No. & Validity
_____________
Survey Meter Make & Model
_____________
Survey Meter Serial No.
_____________
Survey Meter Calibration Due Date
_____________
Emergency Kit Availability (Lead shots, tongs, etc.)
_____________
4Pre-Work Safety Checklist10 fields
Area Barricaded & Caution Signs Posted?
_____________
Cordon-off Distance Calculated & Maintained?
_____________
All Unauthorised Personnel Evacuated?
_____________
Communication System Established (Walkie-talkie)?
_____________
Emergency Contact Numbers Displayed?
_____________
Wind Direction Checked (if applicable)?
_____________
Night Work Lighting Adequate?
_____________
First Aid Kit Available?
_____________
RSO & Radiographer Briefed the Team (TBT)?
_____________
Physical check of emergency source container done?
_____________
5Post-Work Checks & Clearance8 fields
Source Secured in Camera/Container?
_____________
Survey Meter Reading at Source Container Surface (mR/hr)
_____________
Survey Meter Reading at Barricade Perimeter (mR/hr)
_____________
Barricades & Signs Removed?
_____________
Area Declared Safe for Re-entry?
_____________
Time of Work Completion
_____________
Signature of Radiographer (Post-Work)
_____________
Signature of PMC Safety (Post-Work)
_____________
💡 Sample filled excerpt
Location: Pipe Rack, Grid A-B/1-2. Source: Iridium-192, Activity: 35 Ci. Cordon-off Distance: 25 meters. Survey Meter Reading (Post-Work at Container): 1.5 mR/hr. Area declared safe at 04:30 AM.
⚖ Compliance notes
- Fulfills requirements under the Atomic Energy (Radiation Protection) Rules, 2004, governed by AERB.
- Helps comply with BOCW (Building and Other Construction Workers) Rules, 1998, Rule 47 (Use of dangerous and harmful substances).
- Essential documentation for safety audits and to demonstrate due diligence in case of a radiation-related incident.
- Mandatory for any work involving ionizing radiation on construction sites, especially for pressure vessels, piping, and critical structural welds.