RSD/NG-STATUS/PROFORMA (C)

Government of India
Atomic Energy Regulatory Board
Radiological Safety Division
Niyamak Bhavan,
Anushaktinagar,
Mumbai 400 094

PROFORMA OF PARTICULARS REGARDING NUCLEONIC GAUGES / ANALYZERS AVAILABLE
IN THE INSTITUTION

This status report should be forwarded by the authorized user of the nucleonic device to Director RSD, AERB, in
the first week of J anuary & J uly every year, as per the terms and conditions of the authorization issued under the
Radiation Protection Rules, 1971.

1. Attach extra sheets, if required.
2. Details of all the nucleonic gauges / analyzers, hereinafter referred to as Nucleonic Device(s), in the
possession of the institution are to be furnished in the format.
3. Nucleonic Devices not in use should be dismantled and disposed off at the earliest with the prior
approval of AERB.
4. For further details of the regulatory requirements and relevant proformas in respect of nucleonic
gauges, refer to our website at: www.aerb.gov.in
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1. Name of the consentee:
(Person in whose name authorization has been issued by AERB)
Designation:
Name and Address of the institution:

2. Name of the Radiological Safety Officer and
the Ref and date of AERB approval :

3. Name and address of the person in charge to be contacted
in case of emergency :

4. (a) Total number of nucleonic devices installed and in use:
(b) Total number of devices which are temporarily not in use:
(c) Total number of devices which are to be disposed off:
(d) Steps being taken to dispose of disused sources, if any :

5. Details of radiation survey meters in working condition available on the site of use

Details 1 2 3
Make
Model
Sr. No
Date of
calibration


6. Have the representatives of AERB inspected the Nucleonic Device installations?
If yes, mention their names, dates of inspection and recommendations if any.



7. DETAILS OF NUCLEONIC GAUGES

Sr
No
Make & Model of
nucleonic devices
Number
Of
nucleonic
devices
Source &
Activity

Location/
Plant name
Reference No. of
NOC issued by
AERB/BARC
Present status of
the device
(In use / To be
installed/
disposed off)























I hereby certify that the above particulars are true to the best of my knowledge and belief and are in complete
conformity with the applicable terms and conditions of authorization and that the sources in our possession have
been physically verified by me and found satisfactory from radiation safety point of view.


Signature & Name of the RSO of Signature, Name and designation
the institution of the consentee with seal.

Place:
Date: