Add Wearers – Radiation Protection Service Cardiff

I confirm that all wearers to be added are non-classified and 18 years of age or over. *

Please confirm by ticking the box.

Note: If you wish to add a person under 18 years of age, or anyone who is a classified worker, please contact us to discuss your requirements.

Your Details

Your Name: *

Email *

Telephone Number *

Location Details

Site / Location *

First 5 characters of Dept ID (e.g. 1111A), or ECN (5 digits) *

This can be found on the front of any documentation we send.

Dosimetry Requirements

Please note: You should receive your dosemeter/s within 7-8 working days of your request. If you require dosemeters earlier we can arrange for your dosemeters to be with you within 2-3 working days. There will be a surcharge of £2 per dosemeter for the latter and you will need to contact us after submitting this form to make the necessary arrangements.

Monitoring Period *

Start date *

Immediate Issue?

Please note, it can take up to 10 working days for our supplier to fabricate and send dosemeters. If you require a dosemeter more urgently we can send them from our stock of spares if we have them in stock. However, this will incur a surcharge of £2 per dosemeter and stocks are limited so this may not be an option. We will inform you if this is the case.

End Date

HSE Category / Job Title of Badge Wearers *

Please click on the help button below for an explanation of the different types of dosemeter, and how to determine your requirements.

Badge Type Dosemeter - Default Holder *

Trunk - Purple
Area Monitor - Yellow
Outside Apron - Red
Left Foot - White
Right Foot - White

If holders are requested, default holder colours are issued unless you tick the box for MRI compliant holders. Please request holders only if you have insufficient for the number of wearers within your department. We allow you to hold a small number of surplus holders but you will be charged for any holders not returned at the end of your contract.

Holders Required

MRI Compliant

Extremity Dosemeters (Monthly Issue Only)

Left Finger Ring TLD *
Right Finger Ring TLD *
Headband TLD
Left Finger Stall *
Right Finger Stall *

* Ring Dosemeters are adjustable. Stalls are available in two sizes. You will be able to select the sizes for each individual as you add them in the Wearer Details section on the next page.

Wearer Details

Please note: Wearer name is limited to 20 character total length. If the total name length exceeds this, RPS Cardiff will truncate the name.

Name (1) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (2) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (3) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (4) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (5) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (6) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (7) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (8) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (9) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Add Another Wearer

Name (10) *

First

Last

Previously Monitored by RPS Cardiff? *

Stall Size *

Standard
Large

Agreement

Personal information provided on this form is treated in confidence and in accordance with the Data Protection Act 2018. The information will be used to enable the supply of personal radiation dosemeters and prepare individual radiation exposure records. We may share information with selected third parties in fulfilling these obligations. Information will not be utilised or shared for any other form than for the purpose for which it is collected and will be kept securely within the terms of the Act.

I have read and understood the statement above regarding data protection and am authorised to make this change. *

I Agree

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