Radioactive Materials Licensing Forms / Postings

Forms / Postings Useful for all types of Licenses

Notice to Employees  (PDF, 32 KB) [See Note A for references]

Occupational Exposure Record per Monitoring Period  (PDF, 89 KB) [See Note C for references]

Cumulative Occupational Exposure History (PDF, 149 KB), [See Note C for references]

Certificate of Disposition of Materials - F 45007 [See Wisreg 1556 Vol. 1 (PDF, 840 KB)]

Reciprocity Privileges Checklist (PDF, 92 KB)

Pertaining to Reciprocity Under a General License   (PPH 45057) (PDF, 37 KB)

Forms / Postings Useful for General Licenses

General License Information Sheet (PPH 45056) (PDF, 34 KB)

Pertaining to Use of Depleted Uranium Under a General License  (PPH 45058) (PDF, 37 KB)  

Pertaining to Use of Radioactive Material for certain In Vitro Clinical or Laboratory Testing Under a General License (PPH 45059) (PDF, 67 KB) 

Certificate - In Vitro Testing with Radioactive Material Under General License  (F 45011) (PDF, 21 KB)  

Certificate - Use of Depleted Uranium under General License  (F 45023) (PDF, 308 KB)

[See DHS 157 (exit DHS; PDF,  1.6 MB) - Subchapter II, # 11 (1) (c) 3, pg 23)

Forms / Postings Useful for Specific Licenses

Application for Radioactive Material License Authorizing the Use of Sealed Sources in Portable Gauges or XRF Devices (F 45006)

Application for Radioactive Material License Authorizing the use of Sealed Sources in Fixed Gauge Devices (F 45009) 

Application for Radioactive Material License for Medical use  
(F 45008)   

Application for a Radioactive Material License for Radiopharmacy  (F 45012)

Application for a Radioactive Material License Authorizing the Use of Industrial Radiography (F 45013)  

Application for a Radioactive Material License Authorizing the Use of Self Shielded Irradiators  (F 45014)  

Application for Radioactive Material License for Broad Scope (F 45015)

Application for a Radioactive Material License for Academic, Research and Development and Other Licenses of Limited Scope (F 45016)

Application for Radioactive Material License for Sealed Sources   
(F 45017)

Application for (Other) Radioactive Material License (F 45022)  

Training, Experience and Preceptor Attestations (F 45010 A-G)

Last Revised: November 23, 2014