Radiation Safety Assessment

Assessment Date: January 1, 2050

Assessor Name: [Your Name]

ASSESSMENT DETAILS

• Radiation Source: X-ray Machine

• Location: Radiology Department

ASSESSMENT OBJECTIVES

• To evaluate the awareness and understanding of radiation safety protocols.

• To ensure compliance with radiation safety measures to protect employees and the public.

• To identify potential areas for improvement in radiation safety practices.

ASSESSMENT QUESTIONS

Please respond to the following questions and statements by marking the appropriate options:

1. Are you aware of the potential risks associated with the radiation source used in your work?

• Yes

• No

2. Have you received radiation safety training specific to your job role?

• Yes

• No

3. Do you use personal protective equipment (PPE) when working with radiation sources?

• Always

• Sometimes

• Rarely

• Never

4. Are radiation warning signs and labels clearly visible in the area where you work?

• Yes

• No

5. Are there established procedures for reporting radiation safety concerns or incidents?

• Yes

• No

6. Do you feel confident in your ability to work safely with radiation sources?

• Very confident

• Somewhat confident

• Not confident

RECOMMENDATIONS AND COMMENTS

Please provide any additional comments, suggestions, or recommendations related to radiation safety at your workplace:

(signature)

[Your Name]

Assessor

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