Va. Admin. Code tit. 12, agency 5, ch. 481, pt. XIV, art. 4, form FORMS (12VAC5-481)

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Current through Register Vol. 41, No. 10, December 30, 2024

Form - FORMS (12VAC5-481)

Applications for a New Radioactive Material License

Academic, Research and Development, and Other Licenses of Limited Scope, Revision 4 (6/2018)

Broad Scope, Revision 3 (1/2016)

Fixed Gauge Devices, Revision 4 (6/2018)

Industrial Radiography, Revision 4 (6/2018)

Irradiators - Part XII, Revision 2 (6/2018)

Medical Use, Revision 4 (1/2022)

Portable Gauges, Revision 3 (6/2018)

Radiopharmacy, Revision 2 (6/2018)

Sealed Sources, Revision 4 (6/2018)

Self-Shielded Irradiators, Revision 4 (6/2018)

Material in Well Logging, Tracer, and Field Flood Study, Revision 3 (1/2016)

XRF Devices, Revision 3 (6/2018)

Manufacturing and Distribution, Revision 3 (6/2018)

Applications for Renewal of a Radioactive Material License

Academic, Research and Development and Other Licenses of Limited Scope, Revision 4 (6/2018)

Broad Scope, Revision 3 (1/2016)

Fixed Gauge Devices, Revision 4 (6/2018)

Industrial Radiography, Revision 4 (6/2018)

Irradiators - Part XII, Revision 1 (6/2018)

Medical Use, Revision 4 (1/2022)

Portable Gauges, Revision 5 (6/2018)

Radiopharmacy, Revision 2 (6/2018)

Sealed Sources, Revision 4 (6/2018)

Self-Shielded Irradiators, Revision 4 (6/2018)

Material in Well Logging, Tracer, and Field Flood Study, Revision 3 (1/2016)

XRF Devices, Revision 5 (6/2018)

Manufacturing and Distribution, Revision 3 (6/2018)

Training, Experience, and Preceptor Attestations

A - Training Preceptor for Radiation Safety Officer and Assistant Radiation Safety Officer Revision 1 (1/2022)

B - Authorized User Written Directive Not Required Revision 1(1/2022)

C - Authorized User Unsealed Radioactive Material Requiring Written Directive Revision 3 (1/2022)

D - Authorized User-Manual Brachytherapy Revision 2 (1/2022)

E - Authorized User High Dose Remote Afterloader-Teletherapy-Gamma Knife Revision 1 (1/2022)

F - Authorized Medical Physicist or Ophthalmological Physicist Revision 1 (1/2022)

G - Authorized Nuclear Pharmacist Revision1 (1/2022)

Other Forms

Certificate of Disposition of Materials, Revision 0 (7/2016)

Certificate - Use of Depleted Uranium under General License, Revision 0 (7/2016)

Cumulative Occupational Exposure History, Revision 1 (1/2015)

Fingerprint Record, Federal Bureau of Investigation, FD-258, (rev. 9/2013)

Notice to Employees, RH-F-12 (1/2011)

Occupational Exposure Record per Monitoring Period, Revision 1 (1/2015)

Registration Certificate - In Vitro Testing with Radioactive Material under General License, Revision 0 (7/2016)

Reciprocity Privileges Checklist, Revision 0 (7/2016)

Application for Reciprocal Recognition of Out-of-State Radioactive Materials License, Revision 0 (2/2021)

Reciprocity Notification, Revision 0 ( 2/2021)

Va. Admin. Code tit. 12, agency 5, ch. 481, pt. XIV, art. 4, form FORMS (12VAC5-481)

Derived from Virginia Register Volume 37, Issue 25, eff. 1/14/2022.

Statutory Authority: § 32.1-229 of the Code of Virginia.