Radiography Permit Template

Improve radiation safety and manage non-destructive testing operations with confidence using this Free Radiography Permit PDF Template. Designed for companies that perform industrial radiography, weld inspection, pipeline testing, structural examination, and other radiation-based NDT activities, this professional permit form helps control hazards, verify equipment readiness, and ensure proper approvals before radiography work begins. It is ideal for oil & gas facilities, refineries, fabrication yards, construction projects, shipyards, power plants, manufacturing sites, and inspection contractors that require a dependable permit-to-work system.

This professionally designed 2-page template is clear, practical, and easy to complete. It helps supervisors, qualified radiographers, assistants, radiation safety officers, and safety teams document work details, assess risks, verify controls, and maintain clear authorization records for every radiography task. Whether using gamma sources or X-ray equipment, this template supports safer planning and stronger compliance procedures.

Key Features

✔ Designed for Industrial Radiography Work
Use for weld inspection, piping examination, vessel testing, structural steel inspection, fabrication quality control, and field radiography operations.

✔ Supports Gamma & X-Ray Methods
Includes radiography type options for Gamma and X-Ray systems, with source or equipment details.

✔ Complete Work Information Section
Includes permit number, project name, exact work location, component or area to be radiographed, isotope type, activity level, work description, and start/end dates.

✔ Personnel Competency Verification
Record supervisor, safety officer, qualified radiographer, radiographer assistant, and Radiation Safety Officer (RSO) details with training certificate and medical fields.

✔ Built-In Job Safety Analysis (JSA)
Identify work steps, hazards, and control measures before radiography starts.

✔ OSHA-Based Safety Checklist
Includes pre-work checklist aligned with OSHA 1910.1096 requirements. Covers equipment certification, source serial numbers, lock mechanisms, guide tubes, collimators, survey meters, and alarm ratemeters.

✔ Radiation Area Control Section
Verify controlled areas, radiation boundaries, barricades, warning signs, flashing lights, and audible alarms where required.

✔ Dosimetry & Exposure Control
Confirm personal dosimeters, electronic alarms, worker dose communication, and ALARA (As Low As Reasonably Achievable) exposure practices.

✔ Emergency Planning & PPE Checklist
Includes emergency response section plus PPE checklist for helmets, gloves, eye protection, safety footwear, high-visibility clothing, respirators, and more.

✔ Authorization Signatures
Includes approval lines for permit issuer, supervisor, and safety officer.

✔ Permit Closure Section
Confirm radiography completed, source secured and locked, radiation survey completed, and permit closed safely.

Perfect For

• NDT Inspection Companies
• Oil & Gas Facilities
• Refineries
• Construction Projects
• Fabrication Yards
• Power Plants
• Safety Managers

Why Choose This Template?

This free Radiography Permit PDF helps reduce radiation risks, improve compliance, and create professional records for industrial radiography operations. Download instantly, print, or use digitally for your team.