Regulation & Licensing

Regulatory Forms

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Accident notification form

The Regulatory Guide: Reporting an Accident is provided to assist licence holders in their compliance with regulation 46. The document defines an 'accident' for the purposes of regulation 46 and provides information on when and how such accidents must be reported.

Accidents should be reported using the following form:

Accident notification form:
DOC 57kb - April 2011

Annual report form for sources & PRFs

This template is the 'approved form' that licence holders should use to fulfil their annual reporting commitments to ARPANSA. It is to be used by source and PRF licence holders, unless the licence specifies other reporting arrangements

Annual report form for sources & PRFs:
XLS 689 kb - April 2013

Construction of an item important for safety - request for approval

This form is to be used to seek approval from the CEO of ARPANSA under Regulation 54 to construct an item important for safety.

Construction of an item important for safety - request for approval under Regulation 54:
DOC 101 kb - January 2016

Disposal or transfer request form - Regulation 53(1) & 53(1A)

This form should be used to seek approval from the CEO of ARPANSA to destroy or otherwise dispose of controlled apparatus or controlled material or to transfer controlled apparatus or controlled material out of Commonwealth jurisdiction. Please refer to the Regulatory Guide for further information.

Disposal or transfer request form - Regulation 53(1) & 53(1A):
DOC 221 kb - August 2015

Instrument of authorisation template

This basic template has been developed to assist with the delegation of responsibility pursuant to regulation 39(4)(b)(ii). Licence holders should modify as required.

Instrument of authorisation template:
DOC 35 kb - February 2012

Licence application form – low hazard source

Applicants who wish to apply for a source licence for a low hazard source, that is, a source in Group 1 of Schedule 3C Part 1 of the Regulations, should use this form. Applicants should refer to the Regulatory Guide: How to Apply for a Source Licence for guidance on how to complete this form or to confirm whether this is the most appropriate application form.

Licence application form – low hazard source:
DOCX 108 kb - May 2016

Licence application form – medium or high hazard source

Applicants who wish to apply for a source licence for a medium or high hazard source, that is, a source in Group 2 or Group 3 of Schedule 3C Part 1 of the Regulations, should use this form. Applicants should refer to the Regulatory Guide: How to Apply for a Source Licence for guidance on how to complete this form, or to confirm whether this is the most appropriate application form.

Licence application form – medium or high hazard source:
DOCX 116 kb - May 2016

NOTE: Applicants who have sources in Group 1 AND sources in Group 2 and /or Group 3 should use the medium-high hazard form.  Applicants are advised to read the Regulatory Guidance to determine the form most appropriate to their needs.

Licence application form – nuclear installation

Applicants who wish to apply for a licence for a nuclear installation should refer to the Regulatory Guide: How to Apply for a Facility Licence for a Nuclear Installation for guidance on how to complete this form.

Licence application form – nuclear installation:
DOCX 110 kb - May 2016

Licence application form – prescribed radiation facility (PRF)

Applicants who wish to apply for a facility licence for a prescribed radiation facility should refer to the Regulatory Guide: How to Apply for a facility licence for a Prescribed Radiation Facility for guidance on how to complete this form.

Licence application form – prescribed radiation facility
DOCX 111 kb - May 2016

Quarterly report form

This template is the 'approved form' that licence holders should use to fulfil their quarterly reporting commitments to ARPANSA. It is to be used by all licence holders, unless the licence specifies other reporting arrangements.

Quarterly report form:
XLS 698kb - July 2016

Regulation 51 request for approval

This form is to be used to seek approval from the CEO of ARPANSA to make a relevant change that will have significant implications for safety under regulation 51.

Regulation 51 request for approval:
DOC 83 kb - January 2015

Source inventory workbook

The Source Inventory Workbook (SIW) is the form approved by the CEO for applicants and licence holders to record details of all controlled material and controlled apparatus to be dealt with under an ARPANSA licence. An explanation of terms and required information is provided on the first worksheet.

Source Inventory Workbook:
EXCEL 2.3 mb - May 2015

Source transfer notice (Regulation 53(2))

This form is to be used to advise the CEO about the transfer of controlled apparatus or controlled material within the Commonwealth. This form must be received within seven days of the transfer. Transfer of sources outside Commonwealth jurisdiction requires the prior approval of the CEO using the Disposal or Transfer Request Form.

Source Transfer Notice:
DOCX 48 kb - July 2015

Transfer request form for security enhanced source

This form is to be used by licence holders seeking approval to transfer security category 1, 2 or 3 sources to another Commonwealth licence holder. Such transfers require prior approval by the CEO of ARPANSA under the Code of Practice for the Security of Radioactive Sources (RPS11).

Request for Approval to Transfer:
DOC 70 kb - February 2014


The CEO invites feedback on the usefulness of any of ARPANSA's regulatory documents. Comments may be made via email to licenceadmin@arpansa.gov.au or mail to:

Chief Inspector
Regulatory Services
ARPANSA
PO Box 655
Miranda NSW 1490

If you experience difficulty completing any form please call (02) 9541 8330 for assistance.

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