RADMAT Forms / Postings

INITIAL APPLICATIONS

Please submit the initial application electronically to RADMAT. The application should either be signed and scanned in as a pdf or be sent as a word document and include an electronic signature. The application fee can either be paid by check with the application or by credit card. Please refer to the “Fee Schedule Page” for viewing the fee schedule and a link to pay on-line.

RENEWAL APPLICATIONS

Please submit the initial application electronically to RADMAT. The application should either be signed and scanned in as a pdf or be sent as a word document and include an electronic signature.

Training, Experience and Preceptor Attestations

Attestation-A, (Radiation Safety Officer and Associate Radiation Safety Officer For Medical Use)

Attestation-B, (Authorized User -Written Directive Not Required)

Attestation-C, (Unsealed Radioactive Material Requiring A Written Directive)

 

Attestation-D, (Authorized User For Manual Brachytherapy Sources)

Attestation-E, (Authorized User Of Remote Afterloader, Teletherapy Or Gamma Stereotactic Radiosurgery Units)

Attestation-F, (Authorized Medical Physicist)

Attestation-G, (Authorized Nuclear Pharmacist)

Forms / Postings Useful for all types of Licenses

Notice to Employees

Occupational Exposure Record

Cumulative Occupational Exposure Report 1-15

Certificate of Disposition of Materials

Reciprocity Privileges Checklist

Forms / Postings Useful for General Licenses

Pertaining to Use of Depleted Uranium Under a General License    

Forms Useful for scrap/trash

DOT-10656 Exemption for scrap loads

DOT-11406 Exemption for trash loads

Office of Radiological Health | 109 Governor Street,  7th Floor | Richmond, VA  23219

Telephone (804) 864-8150 | Fax: (804) 864-8155

 

Last Updated: May 2, 2024