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Forms

Radioactive Material

Document

 Description

Form RM

Application for a Radioactive Materials License

Form
RM-HU (AUD)

Preceptor Form for Physicians Wishing to be Authorized for Use of Unsealed Radioactive Materials and Diagnostic Sealed Sources for which a Written Directive is Not Required

Form
RM-HU (AUT)

Preceptor Form for Physicians Wishing to be Authorized for Use of Unsealed Radioactive Materials for which a Written Directive is Required

Form
RM-HU (AUS)

Preceptor Form for Physicians Wishing to be Authorized for Use of Sealed Source Radioactive Materials for which a Written Directive is Required

Form
RM-HU (RSO)

Preceptor Form for Individuals Wishing to be Authorized for Medical Use Radiation Safety Officer

Form
RM-HU (AMP)

Preceptor Form for Individuals Wishing to be Authorized as Therapeutic Medical Physicists

Form
RM-HU (ANP)

Preceptor Form for Individuals Wishing to be Authorized as Nuclear Pharmacists

Form
RH 313R

Radioactive Material Application Addendum for Industrial Radiography (Corporate Structure)

Form SM

Application for a Source Material License

Form DRM

Disposition of Radioactive Material (Documentation of Proper Transfer or Disposal)

Form GL

Registration of General License Devices

Form RR

Request to Work In Alabama Under Reciprocity

View Schedule

Fee Schedule for Radioactive Material Licensees after August 28, 2014

Form S

Medical Misadministration Report

Form
Small Entity

Certification of Small Entity Status for Annual Fees

Form Y

Cumulative Occupational Exposure History

Form Z

Occupational Exposure Record for a Monitoring Period

Machine Registrations

Document

Description

View App

Application for Registration for Sources of Radiation (For Medical X-Ray Tubes with Energies <0.9 MeV)

Form PA-2

Application for Notice of Registration (To Register Accelerators and Cyclotrons with Energies >0.9 MeV)

Form NMX

Application for Non-Medical X-Ray Registration (Industrial X-Ray Units)

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Registration of Radiation Services For Medical X-Ray Equipment

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Registration of Radiation Services For Non-Medical X-Ray Equipment

Form PA-NRS

Application to Register as a Servicer of Particle Accelerators (For Companies)

Form
PA-NRS-1

Application to Register as a Servicer of Particle Accelerators (Supplemental Form for Individuals)

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Radiation Safety Training Certificate for Servicers of X-Ray Equipment

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Request for Handheld Dental X-Ray Exemption

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X-Ray Screening Request

Machine Assembly

Document

Description

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Report of Assembly of Non-Certified X-Ray Systems - i.e. those not reported on Federal Form FD2579

Industrial Radiography Certification

Document

Description

View Schedule

2015 Exam Schedule and General Information - Radiographer Examination Schedule

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Application for Industrial Radiographer Examination - Radiographer Cert Application

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Request for Disability Accommodation for Industrial Radiography Examination - Radiography Disability

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Procedure to Replace a Lost or Misplaced Radiographer Certification ID Card - Radiographer Card Replace

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Procedure to Upgrade Radiographer Certification ID Card from Single Purpose (Example:  X-Ray Only) to Dual Purpose (Both X-Ray and RAM) - Radiographer Second Card

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Industrial Radiographer On-The-Job Training (OJT) Form - Radiographer OJT Card

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Industrial Radiographer Qualification Form - Radiographer Qualifications

DOT Exemptions

Document

Description

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Instructions for radiation found in scrap metal

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Exemption Form scrap metal

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Marking scrap metal

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Instructions for radiation found in waste

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Exemption Form waste

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Marking waste

General

Document

Description

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Radiological Emergency Assistance Form

Form X

Notice to Employees

Form 100

Notice of Where Copies of Documents May be Found

 

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