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Category Health and Safety
Type Policy
Approved by Vice-Chancellor
Date Policy Took Effect 15 October 2018
Last approved revision 8 July 2014
Sponsor Chief Operating Officer
Responsible officer Director, Health, Safety and Wellbeing


To recognise the risk of ionising radiation and to identify, manage and comply with current radiation regulation to provide a safe environment.

Organisational scope

The policy applies to all radiation sources managed, controlled, owned or possessed by the University, used by University staff or students, or located on University premises.


Irradiating apparatus
Electrical equipment that is designed to generate ionising radiation such as X-rays, neutrons, electrons, or other charged particles; or produces ionising radiation as a by product resulting in a dose equivalent rate of or exceeding 1 micro Sievert per hour at a point 0.1 metres from any accessible surface and has a maximum energy of or exceeding 5 kiloelectronvolts.
Ionising radiation in the form of particles or waves emitted from a radioactive material or an irradiating apparatus, or both.
Radioactive material
Any material that spontaneously emits ionising radiation, including any naturally occurring radioactive material or any nuclear material.
Radiation source
Radioactive material to which the Radiation Safety Act 2016 applies or an irradiating apparatus.
Source licence
A licence described in section 17, Radiation Safety Act 2016.  A source licence authorises a person to manage and control a radiation source regardless of whether the person owns or has physical possession of the radiation source.
Health, Safety and Wellbeing management tool used by the University to record, measure, and report incidents, near-misses and hazards.


1. Principles

  1. Radiation sources are subject to the Radiation Safety Act 2016.
  2. Compliance is managed centrally through Health and Safety.
  3. All the required regulatory compliance documentation shall be held in the Vault risk management system. This will include:
    1. Identity, location and purpose of all radiation sources in the possession or under the control of the University and its staff.
    2. Radiation Safety Plans for all activities and sources.
    3. Authorised Users of radiation sources by:
      • regulation
      • use licence
      • radiation Safety Plan, or
      • source licence.
    4. User, training and renewal records.
  4. All applications for the use of radiation sources must be lodged with Health and Safety allowing at least one month for processing.

2. Process for source licensing

  1. All University radiation sources will accounted for by a University source licence.
  2. The University is required to hold a number of source licences, but a separate licence for every source or user is not required.
  3. The University will hold source licences and contact with the Radiation Safety Advisor is through the Health and Safety.
  4. The Radiation Safety Adviser, Health, Safety and Wellbeing, is responsible for purchasing any new radiation source.

3. Monitoring and auditing

  1. Health and Safety are responsible for the development and implementation of the auditing programme for monitoring compliance with this policy and the Radiation Safety Act 2016.
  2. All external audits will be conducted via Health and Safety.
  3. Reports on compliance and non-compliances will be provided to the Senior Leadership Team and the Health, Safety and Ethics Compliance Committee.

Related policies, procedures and forms

University of Otago documentation:

Contact for further information

If you have any queries regarding the content of this policy, procedure or guideline or need further clarification, contact:

Radiation Safety Adviser

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