Commonly Requested Radiation Management Forms

Industrial Radiographer Certification
Industrial Radiography Examination Feeupdated Industrial Radiography Examination 2017 Test Datesupdated
Application for Industrial Radiography Examination--DEQ Form #410-5-1updated Radiographer Qualification-- DEQ Form #410-5-2
On-the-Job Training Record Form-- DEQ Form #410-5-3 Disability Accommodation Form-- DEQ Form #410-5-4
New Procedures for Obtaining Individual Licenses/Certifications (Citizen Affidavit)

General
Affidavit Notification to Landowners-- DEQ Form #100-810 (Required for all new permit and license applications updated Radiation Fee Scheduleupdated
Industrial and Analytical X-Ray Machines
New or Renewal X-Ray Application Checklist

Report of Proposed Activities-- DEQ Form #410-241x (X-Ray Reciprocity)

Application for Permit for Radiation Producing Equipment-- DEQ Form #410-13-1

Handheld X-Ray Guidance

Registration of Industrial and Analytical X-Ray Machines-- DEQ Form #410-13-2

 

Radiation Machines Used for Therapy

Application for Permit for Radiation Producing Equipment Therapeutic X-Ray Systems-- DEQ Form #410-11-1 Registration of Therapy X-Ray Systems-- DEQ Form #410-11-2

Radioactive Materials Program

Notice to Employees-- DEQ Form #410-3 Report of Proposed Activities-- DEQ Form #410-241 (Materials Reciprocity): MS Word - PDF
Application for Materials License-- DEQ Form #410-313 Certification of Disposition of Materials--DEQ Form #410-314
Information Needed for Transfer of Control-- DEQ Form #410-TC In-Vitro Clinical and Laboratory Testing-- DEQ Form #410-483
Certification of Small Business Entity Status--DEQ Form #410-526updated  

Registration of Generally Licensed Devices

Generally Licensed Device Site Registration-- DEQ FORM #410-GLD updated

 

Other Forms

Occupational Exposure Record for a Monitoring Period--DEQ Form #410-5 Occupational Exposure Record for a Monitoring Period Instructions--DEQ Form #410-5 (Instructions)

Links

Nuclear Regulatory Commission's Web Page (NUREG Series Publications)