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   (P-45057) (PDF, 37 KB)

Forms / Postings Useful for General Licenses

General License Information Sheet (P-45056) (PDF, 34 KB)

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

Pertaining to Use of Radioactive Material for certain In Vitro Clinical or Laboratory Testing Under a General License (P-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 (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: May 18, 2015