Radioactive Materials Licensing Forms / Postings
Forms and postings useful for all types of licenses
- Notice to Employees, P-45027 (PDF)
- Radiation Exposure to Pregnant Employees, P-45024 (PDF)
- Occupational Exposure Record per Monitoring Period, F-45003 (PDF)
- Cumulative Occupational Exposure History, P-45020 (PDF)
- Certificate of Disposition of Materials [See WISREG 1556 Vol. 1 (PDF)]
- Reciprocity Privileges Checklist, F-45019 (PDF)
- Pertaining to Reciprocity Under a General License, F-45057 (PDF)
Forms and postings useful for general licenses
- General License Information Sheet, P-45056 (PDF)
- Pertaining to Use of Depleted Uranium Under a General License, P-45058 (PDF)
- Pertaining to Use of Radioactive Material for certain In Vitro Clinical or Laboratory Testing Under a General License, P-45059 (PDF)
- Certificate - In Vitro Testing with Radioactive Material Under General License, F-45011 (Word)
- Certificate - Use of Depleted Uranium under General License, F-45023 (PDF)
- See DHS 157, - Subchapter II, # 11 (1) (c) 3, page 23 (PDF)
Forms and 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 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 (Other) Radioactive Material License, F-45022
Training, experience and preceptor attestations
- Attestation-A, (Radiation Safety Officer For Medical Use), F-45010a
- Attestation-B, (Authorized User - Written Directive Not Required), F-45010b
- Attestation-C, (Unsealed Radioactive Material Requiring A Written Directive), F-45010c
- Attestation-D, (Authorized User For Manual Brachytherapy Sources), F-45010d
- Attestation-E, (Authorized User Of Remote Afterloader, Teletherapy Or Gamma Stereotactic Radiosurgery Units), F-45010e
- Attestation-F, (Authorized Nuclear Pharmacist), F-45010f
- Attestation-G, (Authorized Medical Physicist), F-45010g