The following are the six questions that the General
Licensee will be asked to complete on the self-inspection form when it is
mailed with the annual bill.
1. Has the contact person changed?
2. Has the number of devices containing radioactive
material changed in the past year?
3. If device has been transferred to another licensee, was
the Department of Health Services been notified within 30 days?
Wis. Adm. Code, DHS 157.12(4)
4. Are all radiation warning signs and labels visible and
in good condition on the device?
5. Are all Devices containing Radioactive Material in
working order (For example damage to shielding, On/off mechanism or
indicator failure, leak test exceeds 0.005mCi)?
6. Has the device been leak tested within the last six
months or as required by the Sealed Source Device Registry?
Last Revised: December 28, 2011