Notice to Employees (Word, 57 KB)
Occupational Exposure Record (Word, 77 KB)
Cumulative Occupational Exposure History (Word, 70 KB)
Certificate of Disposition of Materials (Word, 46.5 KB)
Reciprocity Privileges Checklist (Word, 6 KB)
Pertaining to Use of Depleted Uranium Under a General License (Word, 13.66 KB)
Application for Radioactive Material License Authorizing the Use of Sealed Sources in Portable Gauges or XRF Devices
Form Fillable Version (Word, 83.5 KB)
Application for Radioactive Material License Authorizing the use of Sealed Sources in Fixed Gauge Devices (DPH 45009)
Form Fillable Version (Word, 76.5 KB)
Application for Radioactive Material License for Medical use
Form Fillable Version (Word, 179 KB)
Application for a Radioactive Material License for a Commercial Radiopharmacy
Form Fillable Version (Word, 130 KB)
Application for a Radioactive Material License Authorizing the Use of Industrial Radiography
Form Fillable Version (Word, 105 KB)
Application for a Radioactive Material License Authorizing the Use of Self Shielded Irradiators
Form Fillable Version (Word, 83.5 KB)
Application for a Radioactive Material License Authorizing the Use of Pool Irradiators
Form Fillable Version (Word, 83.5 KB)
Application for Radioactive Material License for Broad Scope
Form Fillable Version (Word, 106 KB)
Application for a Radioactive Material License for Academic, Research and Development and Other Licenses of Limited Scope
Form Fillable Version (Word, 95 KB)
Application for Radioactive Material License for Sealed Sources
Form Fillable Version (Word, 77 KB)
Application for Radioactive Material License for Well Logging
Form Fillable Version (Word, 106 KB)
Application for In Vitro
Training, Experience and Preceptor Attestations
Attestation-A, (Radiation Safety Officer For Medical Use)
Form Fillable Version (Word, 95.5 KB)
Attestation-B, (Authorized User -Written Directive Not Required)
Form Fillable Version (Word, 96.5 KB)
Attestation-C, (Unsealed Radioactive Material Requiring A Written Directive)
Form Fillable Version (Word, 135 KB)
Attestation-D, (Authorized User For Manual Brachytherapy Sources)
Form Fillable Version (Word, 154 KB)
Attestation-E, (Authorized User Of Remote Afterloader, Teletherapy Or Gamma Stereotactic Radiosurgery Units)
Form Fillable Version (Word, 97.0 KB)
Attestation-F, (Authorized Medical Physicist)
Form Fillable Version (Word, 87.0 KB)
Attestation-G, (Authorized Nuclear Pharmacist)
Form Fillable Version (Word, 80.0 KB)
DOT-1056 Exemption for scrap loads
DOT-11406 Exemption for trash loads
Radiological Health Program | James Madison Building, 7th Floor | 109 Governor Street, Room 730 | Richmond, VA 23219 | Telephone (804) 864-8150 | Fax: (804) 864-8155