X-Ray Safety Inspection Audit Form
Goodwill Industries of Wayne and Holmes Counties
Date
*
-
Month
-
Day
Year
Date
Location
*
Auditor
*
First Name
Last Name
Auditor Signature
*
Audit Questions
Tax Identification Number Posted
*
Current Certificate of Registration Posted (Bi-Annual Renewal)
*
Current Copy of OAC Chapter 3701:1-38 in PA>M>Safety>E-Commerce>Rule Guidance
*
Notice to Employees (OAC 3701:38-10 (A)(1) form HEA 5503 posted in E-Commerce Office
*
Notice to Employees poster in PA>M>Safety>E-Commerce>Notice to Employees
*
Current Copy of 3701:1-68-04 Industrial analytical radiation-generating equipment in PA>M>Safety>E-Commerce>Rule Guidance
*
Annual Training for Employees in E-Commerce and the Safety and Loss Prevention Specialist - see Training Department in PA>Training>Safety>Radiation Program Training
*
DXL User Guide in PA>M>Safety>E-Commerce>User Manuals
*
DXL Quickstart Guide in PA>M>Safety>E-Commerce>User Manuals
*
On Line Training Procedure in PA>M>Safety>E-Commerce>User Manuals
*
Training Certificates from Thermo Fisher - yearly for all employees in E-Commerce
*
Instruction to Workers information in PA>M>Safety>E-Commerce>User Manuals
*
Signed Instruction to Worker form in each employees training records - yearly
*
Log Book is filled out for each usage - see Ultization Form
*
List of Authorized Users is verfied with manager (see S>PA>M>Safety>E-Commerce>List of Authorized Users).
*
Printed User Manual at station containing procedure, rule guideance 37016804 and user manual
*
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: