Application for Registration of Designated Radiation Equipment Class 3b and 4 Lasers

Transcription

1 Applicatin fr Registratin f Designated Radiatin Equipment Class 3b and 4 Lasers OWNER INFORMATION Is this equipment wned by a Zne? Yes N If yes, which Zne? If n, please cmplete the fllwing: Owner Name: Street Address: City: Telephne Number: Cntact Name: Pstal Cde: Fax Number: FACILITY INFORMATION Facility Name: Address: City: Telephne Number: Cntact Name: Pstal Cde: Fax Number: PLEASE INDICATE WHERE THE EQUIPMENT IS LOCATED: Cardilgy Dental Dermatlgy Obs/Gyneclgy Onclgy Ophthalmlgy Physitherapy Pdiatry Radilgy Research Surgery Other TYPE OF DESIGNATED EQUIPMENT A. Please select the apprpriate infrmatin: Class 3b Class 4 B. This equipment is: Statinary Mbile Temprary until: EQUIPMENT INFORMATION Lcatin within facility: Manufacturer: Mdel Number: Manufacturer Date: Serial Number: If equipment is frm anther facility, please indicate facility name: Applicatin fr Registratin f Designated Radiatin Equipment LASER Page 1

2 Applicatin fr Registratin f Designated Radiatin Equipment Class 3b and 4 Lasers I certify that, t the best f my knwledge, the infrmatin in this applicatin is cmplete and accurate, and that this equipment and the radiatin facility assciated with its use, cmply with the Radiatin Prtectin Act and Regulatin. Owner signature: Date: Please cmplete and return t the Cllege f Physicians & Surgens f Alberta Eve Behr, Accreditatin and Radiatin Equipment Analyst eve.behr@cpsa.ab.ca Fax: Yur privacy is imprtant t us! We cllect, use and/r disclse yur persnal infrmatin with yur cnsent unless therwise authrized r required by legislatin. As per ur CPSA Privacy Statement, we cllect and use yur persnal infrmatin t d ur Cllege wrk, which is t prtect the public and t guide and regulate Alberta physicians. PRINT FORM BUTTON HERE Applicatin fr Registratin f Designated Radiatin Equipment LASER Page 2

3 Owner Respnsibilities Radiatin equipment cannt be used until a CPSA registratin certificate has been issued. Register equipment accrding t CPSA step-by-step instructins. Recertify equipment accrding t CPSA step-by-step instructins. Ensure a cpy f the riginal CPSA Certificate f Registratin fr equipment is n-site at the facility w it is registered. Pay the ne-time registratin fee(s) and subsequent annual renewal fee(s) in a timely manner. Submit annual cnfirmatin f laser equipment prfile(s) with/withut changes back t CPSA. Ntify CPSA f equipment that is discarded, stred, sld, leased, r transferred* within 30 days: Cmplete and submit Ntificatin f Change frm with sectin C cmpleted Return riginal CPSA Certificate f Registratin If required, advise CPSA f new wner name and/r new lcatin If equipment is sld, yur respnsibility is t infrm the new wner t register with CPSA prir t perating.* Infrm CPSA prir t resuming use f stred equipment. Stred equipment must be re-tested by an Authrized Radiatin Prtectin Agency (ARPA) and new CPSA certificate issued when: Certificate s expiry date has lapsed OR Placed in strage fr lnger than ne mnth Ntify CPSA f relcated equipment - Cmplete and submit Ntificatin f Change frm with sectin B cmpleted Ntify CPSA f equipment mdificatins - Cmplete and submit Ntificatin f Change frm with sectin A cmpleted Re-testing may be required *Radiatin Prtectin Regulatin 13.1 & 13.2

4 FAQ s Why d class 3b/4 lasers require registratin? Class 3b/4 lasers are classified as designated radiatin equipment, as per Sectin 8 f the Radiatin Prtectin Regulatin. Why des CPSA register laser equipment? We are a Radiatin Health Administrative Organizatin (RHAO) in cntract with Alberta Labur t administer the Radiatin Equipment Prgram which is respnsible fr registering physician wned/perated x-ray equipment and class 3b/4 lasers. If a laser is wned by the facility and used by a CPSA registered physician, is it registered at CPSA? Yes. If a laser is wned by the facility and used by ther persnnel (i.e. estheticians, nurses) but nt a physician, is it registered at CPSA? N, if the facility is nt physician-wned it is registered with the Alberta Assciatin fr Safety Partnerships (AASP). If a CPSA physician nly uses the laser ccasinally, is registratin still required? Yes. What is an ARPA? Authrized Radiatin Prtectin Agency facility and equipment inspectrs. ARPA s are a cmpletely independent, separate regulatry-identified grup. ARPA s are nt emplyed by the CPSA. What happens if an ARPA deems ur facility and/r equipment nn-cmpliant? The nn-cmpliance reprt is submitted t CPSA. CPSA sends a fllw-up letter t wner indicating registratin/recertificatin prcess will nt cntinue and equipment must nt be used until: Nn-cmpliance issues reslved and ARPA may need t re-test fr cmpliance Reprt submitted and CPSA registratin certificate issued It is the sle respnsibility f the wner t wrk with the ARPA t achieve facility and/r equipment cmpliance. Once cmpliance is achieved the ARPA will ntify the CPSA; the registratin/recertificatin prcess will cntinue. Can I submit CPSA equipment registratin applicatins t the ARPA? N. Cmpliance verificatin testing is required when: A new laser is purchased. Existing equipment r the facility s structure is mdified. Existing equipment is relcated within the same facility. Existing equipment is transferred t anther facility.

5 Hw d I determine if a laser is class 3b/4? Read the manufacturer s labels n equipment, r read wner manual. Can individuals ther than physicians use lasers fr hair remval? Yes. The registered wner is respnsible fr ensuring all persnnel wh use the laser are apprpriately trained as per manufacturer/vendr instructins/requirements. Why can t I register laser equipment using the paper-based verificatin frm? Only lasers in a recertificatin cycle can take advantage f the paper-based cmpliance verificatin prcess. Why can t equipment be perated withut a registratin certificate? Operatin withut a valid CPSA registratin certificate is in direct cntraventin f the Radiatin Prtectin Act. A stp-use directive will be issued; a fine may be levied n prsecutin frm Alberta Labur. D temprary/laner lasers require registratin? Yes; restrictins are placed n the CPSA registratin certificate. Hw d I maintain laser equipment registratin? Registered wners receive prfiles f all active equipment frm CPSA. Owners are required t review/update prfiles with r withut changes t CPSA. Reviewing equipment prfiles is nt the same prcess as recertifying equipment. What happens if equipment is nt recertified by the expiry date n the certificate? Certificate expiry is in cntraventin f the Radiatin Prtectin Act; a stp-use directive is issued and remains in effect until recertified by the CPSA. Hw d I knw when equipment is expiring? Certificates have an expiry date lcated n the bttm f the left side. It is the wner s respnsibility t ensure equipment is re-tested, recertified and new certificate issued prir t the expiry date. What is the difference between a mbile and a prtable laser? There is n difference. Can I register ne laser t mre than ne facility? Yes.

6 Fr additinal infrmatin n: Registratin Recertificatin Equipment mdificatin/relcatin Decmmissined equipment ARPA listing Fees Please refer t the CPSA Class 3b/4 Laser Equipment web page -