Radioactive materials forms and applications

Obtain a form in Microsoft Word format

License forms and instructions

• Application for a transfer or change of control for a radioactive materials license.
• OR-RH 12 application form for all other radioactive materials licensing.
  • OR-RH 11 instructions for all other radioactive materials licensing form.
• OR-RH 12-30 application for the use of radioactive materials for industrial radiographic operations.
  • OR-RH 11-30 instructions for the application for the use of radioactive materials for industrial radiographic operation.
• Application for a radioactive materials license authorizing the medical use of radioactive materials.
  • Instructions for the preparation of an application for a radioactive materials license for the medical use of radioactive materials.
  • Authorized user training, experience, and preceptor attestation for diagnostic uses of radioactive materials.
  • Authorized User training, experience, and preceptor attestation for unsealed therapeutic uses of radioactive materials (7.36 uses).
  • Authorized User training, experience, and preceptor attestation for sealed therapeutic uses of radioactive materials (7.42 and 7.48 uses).
  • Authorized medical physicist or ophthalmic physicist training, experience, and preceptor attestation.
  • Medical radiation safety officer or associate radiation safety officer training, experience, and preceptor attestation.
  • Authorized nuclear pharmacist training, experience, and preceptor attestation.
  • Instructions for Patients Treated With Iodine-131.
  • Instructions for Patients Treated With Radiopharmaceuticals or Implants.
• OR-RH 12-3.N application for persons providing services for other licensees.
  • OR-RH 11-3.N instructions for application for persons providing services for other licensees.
• Portable nuclear gauge license application.
  • Portable nuclear gauge license application instructions.
• RCD Form 62 certification of small entity status for purposes of annual fees.
• OR-RH-12.PRV application for a provisional license authorizing temporary possession of radioactive material pending disposal.
• DOT-SP 10656 Shipment Approval Form
  • Downloaded blank form from the Conference of Radiation Control Program Directors (CRCPD) Transportation, complete and submit by email to cdphe.hmdSpecialPermit@state.co.us.
• Reciprocity notification form.
• OR-RH 23 Request for Termination of a Radioactive Materials License.
• R-27 Certificate - In-vitro Testing with Radioactive Materials Under a General License.

Radioactive materials inspection form

• Compliance inspection form. (Basic form suitable for many non-medical licenses.)

Miscellaneous

• Annual program audit form for portable gauge users.
• Associate Radiation Safety Officer model appointment form.
• Licensee certification of reviewing official example form.
• Portable nuclear gauge public dose calculations.
  • Guidelines to evaluate compliance with public dose requirements.
• OR-RH 15 notice to employees form-legal size.
  • Standards for protection against radiation, notices, instructions and reports to workers, inspections, employee protection.
• OR-RH 16 Cumulative Occupational Exposure History.
• OR-RH 17 Occupational Exposure Record for a Monitoring Period.
• National Source Tracking System: NRC Form 748.