Istituto Nazionale di Fisica Nucleare LABORATORI NAZIONALI DI LEGNARO
Radiation Protection Service Date
Viale Dell'Università, 2 - 35020 Legnaro (PD) tel: 049 8068322 - Fax: 049 8068889 e-mail: radprot@lnl.infn.it
I declare that:
1)I assume, as the person in charge, the responsibility for the management of the group, as per the attached list, referring to the radiation protection tasks, including the guidance and supervision of the partecipants during the assigned beam time;
2)I read and communicate to the partecipants of the run all UXOHVWREHIROORZHGUHSRUWHGLQLNL radiation protection documents;
3) in case of my absence, I will delegate, in writing, as the person in charge for the experiment, one of my collaborators who must accept the delegation in writing, with specific notation on the accelerator's machine log. The delegated one will assume responsibility for this
" Responsibility Declaration " regarding all legal purposes and implications;
AUTHORIZATION TO PARTICIPATE IN THE BEAMTIME Filling in the boxes "YES" "NO" by LNL Radiation Protection Service
INFN EMPLOYEES YES NO INFN ASSOCIATED YES NO OTHER YES NO
RESPONSIBILITY DECLARATION
takes full responsibility
in relation to the activity that this group will carry out to
I,the undersigned
for the experiment or beamtime
at Laboratori Nazionali di Legnaro in the period from at the accelerator
4) in case of request to enter the experimental area with the beam, I myself, or the one I delegated in writing, undertake to allow the only access of authorized people, aware that there must be no more than two people in the area at the same time;
5) I undertake to check, at the end of the shift, that all participants place their dosimeters in the specific boards and notify to the Radiation Protection Service about any dosimeters not used during the shift, due to absence of one or more people;
6) all the people of the group and engaged in radiation work are classified with regard to radiation protection according to their exposure conditions and are responsible for full compliance with the rules and any other measures taken at LNL for individual and collective safety (Article 118, paragraph 2), letter b), of Legislative Decree no. 101/2020);
7) the experimental conditions will be the following:
Accelerated ion Voltage (MV) Energy (MeV) Current (nA) Target Reaction Cont.d/Pulsed
beam Channel
α Sources
β Sources Neutron Sources Other Sources
Signature
Please note that pregnancy of workers must be promptly communicated as soon as it is ascertained (Legislative Decree 101/2020 Art. 111, paragraph 1), letter e)
8) I communicate to LNL Radiation Protection Service any change in activity than stated I also request, for the beam shift, the availability of the following radioactive sources:
Gamma Sources X Sources
