APM X-Ray Equipment Verification APM X-Ray Equipment Verification Name(s) of Registered Owner(s)(Required)PrefixFirst NameLast Name Add RemoveTo add more rows, press blue plus sign. Full Names of all X-ray Operators(Required)PrefixFirst NameLast NameSuffix Add RemoveInclude owner name if owner is an operator. Indicate non-CCOA member operators (i.e. RTs, as non-RT staff may not operate x-ray). Include current copy of RT’s permit. It is the owner’s responsibility to: a) provide proof of dosimetry for all operators, b) notify the CCOA of new/ceased operators c) ensure all CCOA member operators update online profileUpload necessary RT permits and proof of dosimetry for all operators:(Required)Max. file size: 64 MB. Equipment Location:(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Confirm Imaging Type(Required)Digital system: Computed radiography (C/R) Digital radiography (D/R) Untitled(Required)Film-based: Automatic processing Manual processing Status:(Required) Active Inactive* *If your facility has been decommissioned, you must de-register it. Download and complete the X-ray Deregistration Application on theccoa.ca.*Date Inactive(Required) MM slash DD slash YYYY Declaration I, Name(Required) First Last solemnly declare that: I have read the Radiation Health and Safety Program Manual on the CCOA website and understand the requirements and procedures of the X-ray Quality Assurance Program (QAP). I am competent in the use of x-ray equipment, and I understand that it is my responsibility to ensure that the CCOA’s QAP is maintained in order to meet industry standards for radiology. My QAP includes daily densitometry and sensitometry if my x-ray does not have a digital image capture system. I acknowledge that it is my responsibility to ensure that each operator of my x-ray equipment is issued his or her own dosimeter, is registered as an x-ray operator with the CCOA, and to notify the CCOA of changes in operators. Owner Signature(Required)Date Signed:(Required) MM slash DD slash YYYY Questions? Please feel free to contact registration@theccoa.ca.
