RADIATION SAFETY OFFICER OR 

 ASSOCIATE RADIATION SAFETY OFFICER 

TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION 

[10 CFR 35.57, 35.50] 

NRC FORM 313A (RSO)

(07-31-2023)

U. S. NUCLEAR REGULATORY COMMISSION

NRC FORM 313A (RSO) (07-31-2023) PAGE 1 

Name of Individual

Requested Authorization(s) The license authorizes the following medical uses (check all that apply):

35.100 35.200 35.300 35.400 35.500

*Training and Experience, including board certification, must have been obtained within the 7 years preceding the date of 

 application or the individual must have obtained related continuing education and experience since the required training 

 and experience was completed. Provide dates, duration, and description of continuing education and experience related

 to the uses checked above.

PART I -- TRAINING AND EXPERIENCE 

(Select one of the five methods below)

 1. Board Certification

a. Provide a copy of the board certification.

35.600 (remote afterloader)

35.600 (teletherapy) 35.600 (gamma stereotactic radiosurgery) 35.1000 ( )

b. If the board certification process has been recognized by the Commission or an Agreement State under 

 10 CFR 35.50;

OR

2. Current Radiation Safety Officer (RSO) or Associate Radiation Safety Officer (ARSO) Seeking Authorization 

 to Be Recognized as a RSO or ARSO for the Additional Medical Uses Checked Above

a. Use the table in section 5.c. to describe training in radiation safety, regulatory issues, and emergency procedures 

 for the additional types of medical use for which recognition as RSO or ARSO is sought. 

OR

RSO ARSO

(i) Go to the table in 5c and describe training provider and dates of training for each type of use for which 

 authorization is sought.

(ii) Stop here

c. If the board certification was issued on or before October 24, 2005 and is listed in 10 CFR 35.57 (a)(2);

(i) Provide documentation demonstrating that the individual was using the requested materials and uses 

 on or before October 24, 2005;

b. If board certified, provide a copy of the certificate and stop here.

3. Authorized User (AU), Authorized Medical Physicist (AMP), or Authorized Nuclear Pharmacist (ANP) 

 identified on a license or permit in accordance with 10 CFR 35.50 (c)(2)

a. Provide license number.

b. Use the table in section 5.c. to describe training in radiation safety, regulatory issues, and emergency 

 procedures for all types of medical use on the license.

OR

(ii) Stop here

c. If not board certified and not listed on a medical use license as an RSO before January 14, 2019, skip to and 

 complete Part II Preceptor Attestation. 

c. Stop here.

APPROVED BY OMB: NO. 3150-0120 EXPIRES: 07/31/2026

Estimated burden per response to comply with this mandatory collection request: 4.3 hours. Submittal of the application 

is necessary to determine that the applicant is qualified and that adequate procedures exist to protect the public health 

and safety. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 

A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by email to Infocollects.Resource@nrc.

gov, and the OMB Reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0120), Attn: Desk Officer for 

the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; email: oira_submission@omb.eop.

gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information 

unless the document requesting or requiring the collection displays a currently valid OMB control number.
Description of Training

Radiation physics and 

instrumentation

Location of Training Clock 

Hours

Dates of 

Training*

Radiation protection

Mathematics pertaining to the 

use and measurement of 

radioactivity

Radiation biology

Radiation dosimetry

5. Structured Educational Program for Proposed RSO or ARSO

a. Classroom and Laboratory Training

Total Hours of Training:

RADIATION SAFETY OFFICER OR 

 ASSOCIATE RADIATION SAFETY OFFICER 

TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION [10 CFR 35.57, 35.50] (continued)

U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

NRC FORM 313A (RSO)

4. Individuals applying simultaneously to be the RSO and AU on a new license

a. Documentation of training and experience to be a new AU is attached

b. The new license application is attached.

OR

NRC FORM 313A (RSO) (07-31-2023) PAGE 2 

c. Stop here.
Shipping, receiving, and performing related 

radiation surveys

Choose all applicable sections of 10 CFR Part 35 to describe radioisotopes and quantities used: 35.100, 35.200, 35.300, 35.400, 35.500, 

35.600 remote afterloader units, 35.600 teletherapy units, 35.600 gamma stereotactic radiosurgery units, emerging technologies (provide 

list of devices).

+

Dates of 

Training*

Location of Training/ 

License or Permit Number of Facility Description of Experience

b. Supervised Radiation Safety Experience

PAGE 3

Using and performing checks for proper 

operation of instruments used to determine 

the activity of dosages, survey meters, and 

instruments used to measure radionuclides

Securing and controlling byproduct material

Using administrative controls to avoid 

mistakes in administration of byproduct 

material

Using procedures to prevent or minimize 

radioactive contamination and using proper 

decontamination procedures

Disposing of byproduct material

Using emergency procedures to control 

byproduct material

Licensed Material Used (e.g., 35.100,

35.200, etc.)+ 

(If more than one supervising individual is necessary to document supervised work experience, provide multiple 

copies copies of this section.)

NRC FORM 313A (RSO) (07-31-2023)

RADIATION SAFETY OFFICER OR 

 ASSOCIATE RADIATION SAFETY OFFICER 

TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION [10 CFR 35.57, 35.50] (continued)

U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

NRC FORM 313A (RSO)

5. Structured Educational Program for Proposed RSO or ARSO (continued)
Radiation safety, regulatory issues, and 

emergency procedures for 35.600 - remote 

afterloader uses

The supervising individual is authorized as the 

PAGE 4 

( )

35.100 35.200 35.300 35.400

35.500 35.600 (remote afterloader) 35.600 (teletherapy)

35.600 (gamma stereotactic radiosurgery) 35.1000

c. Describe training in radiation safety, regulatory issues, and emergency procedures for all types of medical use 

 on the license for the RSO or types of use for which the ARSO will be listed on the license. 

b. Supervised Radiation Safety Experience (continued)

(If more than one supervising individual is necessary to document supervised work experience, provide multiple 

copies of this section.)

Supervising Individual License/Permit Number listing supervising individual as a 

Radiation Safety Officer or Associate Radiation Safety Officer

Description of Training

Radiation safety, regulatory issues, and 

emergency procedures for 35.100, 35.200, 

and 35.500 uses

Training Provided By Dates of 

Training*

Radiation safety, regulatory issues, and 

emergency procedures for 35.300 uses

Radiation safety, regulatory issues, and 

emergency procedures for 35.400 uses

Radiation safety, regulatory issues, and 

emergency procedures for 35.600 - 

teletherapy uses

Radiation safety, regulatory issues, and 

emergency procedures for 35.600 - gamma 

stereotactic radiosurgery uses

Radiation safety, regulatory issues, and 

emergency procedures for 35.1000, specify 

use(s):

NRC FORM 313A (RSO) (07-31-2023)

RADIATION SAFETY OFFICER OR 

 ASSOCIATE RADIATION SAFETY OFFICER 

TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION [10 CFR 35.57, 35.50] (continued)

U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

NRC FORM 313A (RSO)

5. Structured Educational Program for Proposed RSO or ARSO (continued) 

for the following medical uses:

Radiation Safety Officer or the

Associate Radiation Safety Officer
c. Training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the 

 license (continued)

d. Skip to and complete Part II Preceptor Attestation.

License/Permit lists supervising individual as:

Radiation Safety Officer 

Authorized User Authorized Nuclear Pharmacist Authorized Medical Physicist

Authorized as RSO, ARSO, AU, ANP, or AMP for the following medical uses:

( )

35.100 35.200 35.300 35.400

35.500 35.600 (remote afterloader) 35.600 (teletherapy)

35.600 (gamma stereotactic radiosurgery) 35.1000

License/Permit Number listing supervising individual

PART II – PRECEPTOR ATTESTATION

Note: This part must be completed by the individual's preceptor. The preceptor does not have to be the supervising 

individual as long as the preceptor provides, directs, or verifies training and experience required. If more than 

one preceptor is necessary to document experience, obtain a separate preceptor statement from each.

Structured Educational Program for Proposed RSO or ARSO

I attest that 

Name of Proposed RSO/ARSO

a structural educational program consisting of both 200 hours of classroom and laboratory training and one year 

of full-time radiation safety experience as required by 10 CFR 35.50(b)(1).

AND

Supervising Individual If training was provided by supervising 

RSO, ARSO, AU, AMP, or ANP. (If more than one supervising 

individual is necessary to document supervised training, provide 

multiple copies of this page.)

NRC FORM 313A (RSO) (07-31-2023) PAGE 5

RADIATION SAFETY OFFICER OR 

 ASSOCIATE RADIATION SAFETY OFFICER 

TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION [10 CFR 35.57, 35.50] (continued)

U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

NRC FORM 313A (RSO)

5. Structured Educational Program for Proposed RSO or ARSO (continued)

Associate Radiation Safety Officer 

has satisfactorily completed

I attest that 

Name of Proposed RSO/ARSO

radiation safety, regulatory issues, and emergency procedures for the following types of use: 

has training in 

Check all that apply:

35.100 35.200

35.300 oral administration of less than or equal to 33 millicuries of sodium iodide I-131, for 

which a written directive is required

35.300 oral administration of greater than 33 millicuries of sodium iodide I-131

35.300 Parenteral administration of any radioactive drug that contains a radionuclide that is primarily used for 

its electron emission, beta radiation characteristics, alpha radiation characteristics, or photon energy 

of less than 150 keV, for which a written directive is required 

First Section

Second Section
NRC FORM 313A (RSO) (07-31-2023) PAGE 6

I am the Radiation Safety Officer for

Name of Facility:

License/Permit Number:

Name of Preceptor (Typed or printed)

Signature

Telephone Number Date

Complete the following for Preceptor Attestation and signature

RADIATION SAFETY OFFICER OR 

 ASSOCIATE RADIATION SAFETY OFFICER 

TRAINING, EXPERIENCE AND PRECEPTOR ATTESTATION [10 CFR 35.57, 35.50] (continued)

U. S. NUCLEAR REGULATORY COMMISSION

(07-31-2023)

NRC FORM 313A (RSO)

PART II – PRECEPTOR ATTESTATION (continued)

I am the Associate Radiation Safety Officer for

Check all that apply:

AND

35.400

35.500

35.600 remote afterloader units

35.600 teletherapy units

35.600 gamma stereotactic radiosurgery units

35.1000 emerging technologies, including:

I attest that 

Name of Proposed Radiation Safety Officer or Associate Radiation Safety Officer

is able to independently fulfill the radiation safety-related duties as:

OR

A Radiation Safety Officer for a medical use licensee. 

An Associate Radiation Safety Officer for a medical use licensee. 

Third Section

Fourth Section