Radiation Source Disposal Notification

About this form

This form is used to notify the Health Protection Service of the permanent disposal, or transfer into another jurisdiction, of a registered radiation source.

When a source is disposed, this form must be completed by the source owner and the certificate of registration must be returned to the Health Protection Service.

For all decommissioned apparatus, a licenced technician must complete the ‘Decommission’ section of this form.

Your personal information

Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.