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Getting Started

Notification of acquisition disposal or relocation of a radiation source
Fields marked with * are required
Do you need to complete this form?
You must already hold a current management licence that authorises the possession and disposal of radiation sources before you can complete this form.You should check your licence before completing this form. Disposal of some types of radiation sources must be endorsed as appropriate by the Department before it takes place.You must use this form to notify the Department when you do any of the following: Take physical possession of a radiation source that your management licence authorises you to have.Dispose of a radiation source that you have been authorised to possess. Disposal includes any arrangement to permanently remove the radiation source from your possession. For example, selling your X-ray unit to another licence holder; permanently disabling your X-ray unit and scrapping the components; returning a sealed radiation source to the manufacturer.Replace a radiation source in your possession. For example, if you upgrade an existing X-ray unit to a newer model, you must submit a notification of acquisition of the new unit and a notification of disposal of the old unit.Move a radiation source from one location to another (including out of Victoria).Information about the anticipated processing time for management licence related applications can be found on our website.
Do you currently hold a management licence?
As shown on your management licence.

Management licence holder details

Notification of acquisition disposal or relocation of a radiation source
Fields marked with * are required

Management licence holder details

Is the management licence holder a company or individual?

Company details

Details (NB: Must be a legal entity such as a company incorporated under the Corporations Act or a legal entity established under some other legislation. A trust or a trustee of a trust or a registered business name that is not also a separate legal entity will not be accepted. Refer to https://www.health.vic.gov.au/radiation/sector-specific-information-for-management-licences for further information)

Management licence holder name

Business address

Note: A full and correct physical address is required. No postal address will be accepted.

Mailing address

Contact person details

Name of person authorised by licence holder to act on licence holder’s behalf.
The person completing this form must be a contact person who has been authorised by the licence holder to act on the licence holder’s behalf for the purpose of the requirements under the Radiation Act 2005. Are you authorised by the licence holder to act on their behalf in relation to all radiation safety requirements (Radiation Act 2005)?
Have you previously submitted proof of authorisation to the Department as specified in the sector-specific information for management licences at https://www.health.vic.gov.au/radiation/sector-specific-information-for-management-licences?
Note : Please attach the document specified in the sector-specific information for management licences found at https://www.health.vic.gov.au/radiation/sector-specific-information-for-management-licences
Note: Only authorised persons may complete this form. For further information please refer to the sector-specific information for management licences found at https://www.health.vic.gov.au/radiation/sector-specific-information-for-management-licences

Contact person details

At least one contact phone number is required *
All correspondence will be sent to the email address listed above.

Notification details

Notification of acquisition disposal or relocation of a radiation source
Fields marked with * are required

Radiation practice details

Site

Please list the details of the site where you wish to conduct the radiation practice.Note: A full and correct physical address is required. No postal addresses will be accepted.

Notification

You now need to tell us about each and every source at this site which is being acquired, disposed of or relocated.
Type of notification

Acquisition details

You now need to tell us the details of the source acquisition.
To add another Radionuclide, click on the Add radionuclide button
To add another Radionuclide, click on the Add radionuclide button
Do you wish to have your licence varied (at not cost to you) to reflect that you no longer wish to be authorised to replace this particular source?
Are you disposing of all radiation sources in your possession and wish to surrender your management licence? This will mean that you will no longer be authorised to conduct a radiation practice.

Disposal details

This number can be found on your current management licence. If you are unsure of the correct number, contact the Department.

Relocation details

Do you wish to have your licence varied (at not cost to you) to reflect that you no longer wish to be authorised to replace this particular source?
This number can be found on your current management licence. If you are unsure of the correct number, contact the Department.
Destination site details
To add another Site, click the Add site button

Confirmation

Notification of acquisition disposal or relocation of a radiation source
Fields marked with * are required

Confirmation

Additional information

Acknowledgement

I understand and acknowledge that: The information provided in this application is true and complete to the best of my knowledge.The Department of Health may refuse this application if it becomes evident that information or any supporting documentation provided is incomplete or false.This application forms a legal document and penalties exist for providing false or misleading information.I have been formally authorised by the management licence holder to act on the licence holder’s behalf for the purpose of the requirements under the Radiation Act 2005.

Privacy statement

The Department of Health is bound by Victoria's privacy laws, including the Information Privacy Act 2000. The Radiation Act 2005 provides that an application for a management licence must include certain information, including information about the radiation sources or kinds of radiation sources in relation to which the applicant will conduct a radiation practice. We will use the personal information provided by you on this form to assess your application for a management licence and to monitor your compliance with the Act. If you do not provide us with this information, we may not be able to assess your application. It is an offence for you to possess a radiation source unless you hold a current management licence that allows the possession of that source.You have the right under FOI legislation to apply for access to, and correction of, your personal information held by the Department. For more information about how to make a request, please visit the Department of Health's FOI website at https://www.health.vic.gov.au/freedom-of-information or call 1300 020 360.Section 136 of the Radiation Act allows the Department to disclose information that it collects under the Radiation Act or the Radiation Regulations 2007 to certain persons and agencies (including the Health Services Commissioner, the Victorian Workcover Authority, the Commonwealth Health Insurance Commission and some practitioner registration boards) for the purpose of performing its statutory functions or to assist other government bodies to perform their functions.

Lodgement

If you are having difficulty completing of submitting this form, please contact:Department of Health
Registration and Licensing
GPO Box 4541
Melbourne VIC 3001
Telephone: 1300 767 469
Email: radiation.safety@health.vic.gov.au
Website: https://www.health.vic.gov.au/public-health/radiation
Department of Health