Government of India Bhabha Atomic Research Centre Radiological Physics & Advisory Division CT & CRS, Anushakti Nagar, Mumbai 400 094 Application for Training & Certification Course for Radiological Safety Officer for Gamma Irradiation Chambers (Category -I Irradiators) 1. Name in full (Block letters): 2. Date of Birth: 3. Permanent address: Affix recent ID card size photograph 4. Official address: (for correspondence) 5.e-mail : 6. contact No. 7. Educational qualification: Degree Name of the University Year of passing Class & marks Subject(s) 8. Particulars of Gamma Chamber Facility candidate represents Use of Gamma Chamber Radiation Source Activity
9. Experience in the field: Yrs 10. Details of training in Radiation Safety: (If attended in the past) 11. Personnel Monitoring Services No. If any: 12. Details of Radiation Monitoring Instruments available: Make & Model Range Details of calibration 13. List of Persons already trained in the above course: Name Year of Training Details of present duties Certified that the above information is correct to the best of my knowledge. Place: Date: Signature of Candidate
Shri./Smt./Kum. ----------------------------------------------------------------------------------is an employee of this institution. We are sponsoring him / her for the above course. Signature of the Sponsoring Authority (Name, designation and address of competent authority with seal) e-mail / Mobile No. office Seal Instructions to the Candidate / Sponsoring authority Pl.send 1. Duly filled in application form with a copy of qualification certificate, self attested 2. Stamp sized photographs (3 copies) for preparation of temporary ID 3. A DD of Rs 8550/- per candidate issued in favour of IARP Training Course, payable at Mumbai Note: 4. Participants will have to make their own lodging and boarding arrangements during the entire course period. Working lunch will be served during course days. 5. Participants will have to be compulsorily physically present during the entire course period. 6. The participants are required to abide by the rules and regulations stipulated / prevailing at the course venue. They will be required to display I-card during their movement in and around the course venue.
7. Medical care of a participant will be the sole responsibility of the candidate / sponsoring authority during the entire course. 8. At the end of the course written and viva-voce examination(s) will be conducted. 9. Passing criteria: Minimum 50 marks in written examination / viva voce & overall 60% aggregate. 10. Wherever possible e-mail ID / contact no. of the participant / sponsoring agency may be given for speedy communication. 11. Completed form in all respects + DD must reach IARP office 12. Participation of the candidates will be confirmed well in advance of commencement of the course.
INSTRUCTION SHEET FOR PARTICIPANT TO REACH THE VENUE Venue : CT & CRS Bldg.(Centre for Training & Certification in Radiological Safety, Adjacent to Niyamak Bhavan, Anushaktinagar, Mumbai-400 094) Course duration : October 29 November 06, 2012 Reporting time : 09.30 am on Monday October 29, 2012 Accommodation Lodging & Boarding : No accommodation would be provided to the participants. : To be borne by the candidate(s). Only working lunch would be served during working days City bus (BEST) : To reach CT&CRS, Anushaktinagar, Mumbai -400 094 From Bandra Terminus, Sion and Chembur : Bus No.371, 505 Ltd. & 352 Ltd., AC 105 NMMT From Dadar Rly Stn : Bus No. 92 Ltd, 502 Ltd., 504 Ltd., 506 Ltd. & 521 Ltd. From Kurla Stn : 501 Ltd. From Lokmanya Tilak Terminus: Local Train to Mankhurd Rly Stn. From Vashi Navi Mumbai : 501 Ltd., 504 Ltd, 505 Ltd., & 506 Ltd Sanpada, NAvi Mumbai: 506 Ltd.; State Transport Bus to Dadar Distance Bus stop for CT & CRS Nearest suburban Railway station : Anushaktinagar Main Gate to CT&CRS < 1 km : While coming from city : BARC Fly-over (Two bus stops after Telecom Factory) : MANKHURD (Central Railway on Harbour Line) 2.2 km from CT&CRS. Address for : Course Coordinator, IARP, R. No. 210, C/O RP&AD, Correspondence CT&CRS, Anushaktinagar, Mumbai-400 094. Contact numbers : Telephone : 022-2559 8660 (except on holidays) Fax: 022-2551-9209 Mr. R. Kannan - Course Coordinator Mobil No: 09820103473 / E-mail : kannan221049@gmail.com Mr. V.V. Shaha Course Co- coordinator Mobile No: 09969419485 / E-mail : vvshaha@yahoo.co.in Note: Participant must carry I-card of the institute, some identification document and this letter to facilitate entry inside A. Nagar.