Regulatory forms

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:

Microsoft Office document iconAccident notification form - Regulation 46(2)(c)
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

Office spreadsheet iconAnnual report for nominated source and prescribed radiation facility licence holders
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.

Microsoft Office document iconRequest for approval - Regulation 54 - Construction of an item important for safety
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.

FileRequest for approval to transfer or dispose of a source
November 2017

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.

FileInstrument of Authorisation
September 2017

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.

FileSource licence application form - Low hazard sources

October 2017

Licence application form – medium hazard source

Applicants who wish to apply for a source licence for a medium hazard source, that is, a source in Group 2 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.

FileSource licence application form - Medium hazard sources

October 2017

NOTE: Applicants who have sources in Group 2 AND sources in Group 1 should use the medium hazard form. 

Licence application form – high hazard source

Applicants who wish to apply for a source licence for a high hazard source, that is, a source in 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.

FileSource licence application form - High hazard sources

October 2017

NOTE: Applicants who have sources in Group 3 AND sources in Group 2 and /or Group 1 should use the high hazard form. 

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.

FileFacility licence application form - Nuclear installation
October 2017

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.

FileFacility licence application - Prescribed radiation facility
October 2017

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.

Office spreadsheet iconLicence holder quarterly report for Sources and Prescribed Radiation Facilities
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.

File Regulation 51 request for approval
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.

FileSource Inventory Workbook
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.

FileSource Transfer Notice

November 2017

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).

FileRequest for approval to transfer
FileRequest for approval to transfer


The CEO invites feedback on the usefulness of any of ARPANSA's regulatory documents. Comments may be made via email to licenceadminatarpansa.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.