Cumulative Occupational Exposure History
Certificate of Disposition of Materials
Reciprocity Privileges Checklist
Pertaining to Use of Depleted Uranium Under a General License
Initial Portable Gauge Application
Initial XRF Application Initial Fixed Gauge Application Initial Medical Application Initial Radiopharmacies Application Initial Radiography Application Initial Irradiator Application Initial Pool Irradiator Application Initial Broad Scope Application Initial Specific Licensee Application Initial Sealed Source Application Initial Well Logging Application Initial In-Vitro Application
Training, Experience and Preceptor Attestations
Attestation-A, (Radiation Safety Officer For Medical Use)
Form Fillable Version (Word, 95.5 KB)
Attestation-B, (Authorized User -Written Directive Not Required)
Form Fillable Version (Word, 96.5 KB)
Attestation-C, (Unsealed Radioactive Material Requiring A Written Directive)
Form Fillable Version (Word, 135 KB)
Attestation-D, (Authorized User For Manual Brachytherapy Sources)
Form Fillable Version (Word, 154 KB)
Attestation-E, (Authorized User Of Remote Afterloader, Teletherapy Or Gamma Stereotactic Radiosurgery Units)
Form Fillable Version (Word, 97.0 KB)
Attestation-F, (Authorized Medical Physicist)
Form Fillable Version (Word, 87.0 KB)
Attestation-G, (Authorized Nuclear Pharmacist)
Form Fillable Version (Word, 80.0 KB)
DOT-1056 Exemption for scrap loads
DOT-11406 Exemption for trash loads
Radiological Health Program | James Madison Building, 7th Floor | 109 Governor Street, Room 730 | Richmond, VA 23219 | Telephone (804) 864-8150 | Fax: (804) 864-8155
Full Version